Encyclopedia of Environmental Health

[6 Volume Set] - eBook PDF

Visit to download the full and correct content document:
https://ebooksecure.com/download/encyclopedia-of-environmental-health-6-volume-s
et-ebook-pdf/
 ENCYCLOPEDIA OF
ENVIRONMENTAL HEALTH

SECOND EDITION
This page intentionally left blank
 ENCYCLOPEDIA OF
ENVIRONMENTAL HEALTH

SECOND EDITION

EDITOR-IN-CHIEF
Jerome Nriagu
University of Michigan, School of Public Health,
Ann Arbor, Michigan, United States

VOLUME 1
Elsevier
Radarweg 29, PO Box 211, 1000 AE Amsterdam, Netherlands
The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom
50 Hampshire Street, 5th Floor, Cambridge MA 02139, United States

Copyright Ó 2020 Elsevier B.V. All rights reserved

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photo-
copying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to
seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the
Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted
herein).

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in
research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers may always rely on their own experience and knowledge in evaluating and using any information, methods,
compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the
safety of others, including parties for whom they have a professional responsibility.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or
damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.

Library of Congress Cataloging-in-Publication Data

A catalog record for this book is available from the Library of Congress

British Library Cataloguing-in-Publication Data

A catalogue record for this book is available from the British Library

ISBN 978-0-444-63951-6

For information on all publications visit our website

at http://store.elsevier.com

Publisher: Oliver Walter

Acquisition Editor: Priscilla Braglia
Content Project Manager: Michael Nicholls
Associate Content Project Manager: Greetal Carolyn
Designer: Greg Harris
EDITORIAL BOARD

EDITOR-IN-CHIEF
Jerome Nriagu
University of Michigan
School of Public Health
Ann Arbor, Michigan
United States

SECTION EDITORS

GUIDELINES AND REGULATIONS

Choon Nam Ong
Director, NUS Environmental Research Institute
Professor, School of Public Heath
National University of Singapore
Singapore
Republic of Singapore

DISPARITIES AND SOCIAL DETERMINANTS OF ENVIRONMENTAL HEALTH

Denise M. Rennie
Associate Dean Academic
School of Science, Engineering and Environment
University of Salford
Manchester

WATER QUALITY AND QUANTITY

Hongliang Liu
Tianjin Municipal Bureau of Health Supervision (Tianjin, P. R. China)
Heping District
Tianjin
People’s Republic of China

v
vi Editorial Board

ENVIRONMENTAL EPIDEMIOLOGY
Jaymie R. Meliker
Professor
Program in Public Health
Department of Family, Population, & Preventive Medicine
Stony Brook University (SUNY)
Stony Brook, New York
United States

METALS/METALLOIDS: EXPOSURE AND HEALTH EFFECTS

Jerome Nriagu
University of Michigan
School of Public Health
Ann Arbor, Michigan
United States

GLOBAL ENVIRONMENTAL HEALTH

Melissa Slotnick
Ann Arbor, Michigan
United States

AIR POLLUTION AND HUMAN HEALTH

Nicola Pirrone
Research Director
CNR - Institute of Atmospheric Pollution Research
Rende
Italy

POLLUTION SOURCES AND HUMAN HEALTH

Oladele Ogunseitan
Presidential Chair
Professor
Department of Population Health and Disease Prevention
Program in Public Health
University of California, Irvine
Irvine, California
United States

COUNTRY AND AREA SPECIFIC ENVIRONMENTAL HEALTH ISSUES

Orish E. Orisakwe
Professor
African Centre of Excellence for Public Health and Toxicological Research
University of Port Harcourt
East-West Road
Choba, Rivers State
Nigeria
 Editorial Board vii

ENVIRONMENTAL MICROBIOLOGY
Panagiotis Karanis
State Key Laboratory of Plateau Ecology and Agriculture
Qinghai University
Director of the Center for Biomedicine and Infectious Diseases (CBID)
Xining City
Qinghai Province
People’s Republic of China

University of Cologne
Medical Faculty and University Hospital
Cologne
Germany

COST-BENEFIT ANALYSIS OF ENVIRONMENTAL HEALTH

Till M. Bachmann
European Institute for Energy Research
Karlsruhe
Germany

NOISE POLLUTION: EXPOSURE AND HEALTH EFFECTS

Toshihiro Kawamoto
Professor Emeritus
Department of Environmental Health
University of Occupational and Environmental Health
Yahatanishi-kuKitakyushu
Japan
This page intentionally left blank
CONTRIBUTORS TO VOLUME 1

Shahira A Ahmed S Barone, Jr

Suez Canal University, Ismailia, Egypt
A Åkesson
Karolinska Institutet, Stockholm, Sweden; and Chaney
Environmental, Beltsville, MD, United States
EC Alexopoulos
Hellenic Open University, Patras, Greece
CF Amábile-Cuevas
Fundación Lusara, México D.F., Mexico
Laborde Amalia
Unidad Pediátrica Ambiental (UPA), Montevideo,
Uruguay; Poison Control Center (CIAT), Montevideo,
Uruguay; and Toxicology Department, Faculty of
Medicine, University of the Republic, Montevideo,
Uruguay
Heidi Amlund
National Institute of Nutrition and Seafood Research
(NIFES), Bergen, Norway
R Andreoli
University of Parma, Parma, Italy
DA Axelrad
US Environmental Protection Agency, Washington, DC,
United States
Lesa L Aylward
Summit Toxicology, Falls Church, VA, United States;
and University of Queensland, Brisbane, QLD,
Australia
W Babisch
Federal Environment Agency, Berlin, Germany
S-O Baek
Yeungnam University, Gyeongsan, South Korea
EB Bakeas
University of Athens, Athens, Greece
US Environmental Protection Agency, Washington, DC,
United States
D Belpomme
Association for Research and Treatments Against Cancer
(ARTAC), Paris, France; European Cancer and
Environment Research Institute (ECERI), Brussels,
Belgium; and Paris V University Hospital, Paris, France
Aurelian Bidulescu
Indiana UniversitydBloomington School of Public
Health, Bloomington, IN, United States
Françoise G Bourrouilh-Le Jan
Agrégée de l’Université, Docteur ès Sciences d’État,
Maître de Conférence h.c., Talence, France
P Brimblecombe
University of East Anglia, Norwich, United Kingdom
AL Bronzaft
Professor Emerita, City University of New York, New
York, NY, United States
M-N Bruné
World Health Organization, Geneva, Switzerland
E Calva
Universidad Nacional Autónoma de México,
Cuernavaca, Mexico
C Carlarne
University of South Carolina, Columbia, SC, United
States
Dipankar Chakrabarti
Jadavpur University, Kolkata, India
Rufus L Chaney
Karolinska Institutet, Stockholm, Sweden; and Chaney
Environmental, Beltsville, MD, United States

Micha Barchana Chi-Hsien Chen

University of Haifa, Haifa, Israel; and Ministry of National Taiwan University (NTU) College of Medicine
Health, Jerusalem, Israel and NTU Hospital, Taipei, Taiwan

ix
x Contributors to Volume 1

Claudio Cocheo L Erdinger

Fondazione Salvatore MaugeridIRCCS, Padova, Italy University of Heidelberg, Heidelberg, Germany
BS Cohen Gary W Evans
New York University School of Medicine, New York, Cornell University, Ithaca, NY, United States
NY, United States
Despo Fatta-Kassinos
RD Cohn University of Cyprus, Nicosia, Cyprus
SRA International, Inc., Durham, NC, United States
Stacey A Fedewa
S Conzen
American Cancer Society, Surveillance Research
University of Chicago, Chicago, IL, United States
Department, Atlanta, GA, United States
Simonetta Corsolini
University of Siena, Siena, Italy Kim T Ferguson
Sarah Lawrence College, Bronxville, NY, United States
Gaurav G Dastane
Institute of Chemical Technology, Matunga, Mumbai, A Fino
India National Research CouncildInstitute of Atmospheric
Pollution Research (CNR-IIA), Monterotondo, Roma,
MH Depledge Italy
Peninsula College of Medicine and Dentistry, Plymouth,
United Kingdom B Foos
Office of Children’s Health Protection, Washington,
Ketan S Desai
DC, United States
Institute of Chemical Technology, Matunga, Mumbai,
India P-G Forkert
Ningombam L Devi Queen’s University, Kingston, ON, Canada
Central University of South Bihar, Patna, India Hermann Fromme
Sarjerao B Doltade Bavarian Health and Food Safety Authority, Munich,
Institute of Chemical Technology, Matunga, Mumbai, Germany
India L García-García
Jonathan Dubnov Instituto Nacional de Salud Pública, Morelos, Mexico
Ministry of Health, Haifa, Israel; and University of M Gauthier-Clerc
Haifa, Haifa, Israel Centre de Recherche de la Tour du Valat, Arles, France;
K Ebi and Université de Franche-Comté, Besançon, France
University of Washington, Seattle, WA, United States T Geurden
Ingrid Eckerman Ghent University, Merelbeke, Belgium
Swedish Doctors for the Environment (LfM), Stockholm, LR Goldman
Sweden Johns Hopkins Bloomberg School of Public Health,
P Eckl Baltimore, MD, United States
University of Salzburg, Salzburg, Austria M Goldoni
WM Edmunds University of Parma, Parma, Italy
Oxford University Centre for the Environment, Oxford, Teufik Goletic
United Kingdom Veterinary Faculty of the University of Sarajevo,
Jessie K Edwards Sarajevo, Bosnia and Herzegovina
University of North Carolina at Chapel Hill, Chapel F Gore
Hill, NC, United States World Health Organization, Geneva, Switzerland
Fumio Eguchi J Grigg
Tokyo University of Agriculture, Tokyo, Japan Barts and the London School of Medicine and Dentistry,
A El-Gammal Queen Mary University of London, London, United
Mercy University Hospital, Cork, Ireland Kingdom
 Contributors to Volume 1 xi

Yue L Guo Panagiotis Karanis

National Taiwan University (NTU) College of Medicine Qinghai University, Xining, Qinghai, P.R. China; and
and NTU Hospital, Taipei, Taiwan University of Cologne, Cologne, Germany
VC Hammen Shankar B Kausley
Helmholtz Centre for Environmental Research-UFZ, Institute of Chemical Technology, Matunga, Mumbai,
Halle (Saale), Germany India; and TCS Research, TRDDC, Pune, Maharashtra,
India
Lijian Han
State Key Laboratory of Urban and Regional Ecology, Alexander P Keil
Research Center for Eco-Environmental Sciences, University of North Carolina at Chapel Hill, Chapel
Chinese Academy of Sciences, Beijing, China Hill, NC, United States
EJ Hanford M Korkmaz
Reno, NV, United States Celal Bayar University, Manisa, Turkey
C Hertzman Jyoti K Kumar
Human Early Learning Partnership, The University of Institute of Chemical Technology, Matunga, Mumbai,
British Columbia, Vancouver, BC, Canada India
Mike Holland JC Lambert
EMRC, Reading, United Kingdom United States Environmental Protection Agency,
H Hollert Cincinnati, OH, United States
RWTH Aachen University, Aachen, Germany
Peter Lercher
MJ Hooth Medical University Innsbruck, Innsbruck, Austria
National Institute of Environmental Health Sciences,
National Institutes of Health, Research Triangle Park, BS Levy
NC, United States Tufts University School of Medicine, Boston, MA,
United States
Steven R Horbal
Indiana UniversitydBloomington School of Public Hongyan Li
Health, Bloomington, IN, United States The University of Hong Kong, Hong Kong, People’s
Republic of China
Adnan A Hyder
Johns Hopkins Bloomberg School of Public Health, JC Lipscomb
Baltimore, MD, United States United States Environmental Protection Agency,
Cincinnati, OH, United States
Lida Ioannou-Ttofa
University of Cyprus, Nicosia, Cyprus Shuchang Liu
P Irigaray Tsinghua University, Beijing, China
Association for Research and Treatments Against Cancer Emmanuil E Malandrakis
(ARTAC), Paris, France; and European Cancer and University of Thessaly, Volos, Greece
Environment Research Institute (ECERI), Brussels,
Belgium V Meineke
Bundeswehr Institute of Radiobiology, University of
Wan-Kuen Jo
Ulm, Munich, Germany
Kyungpook National University, Daegu, South Korea
Moll Maria José A Melhem
Unidad Pediátrica Ambiental (UPA), Montevideo, University of Chicago, Chicago, IL, United States
Uruguay; Red de Atencion Primaria (RAP), RL Melnick
Montevideo, Uruguay; and State Health Service National Institute of Environmental Health Sciences,
Administration (ASSE), Montevideo, Uruguay National Institutes of Health, Research Triangle Park,
Hillary Jufer NC, United States
Pace University, Pleasantville, NY, United States
Marisela Méndez-Armenta
Arianne V Julian Instituto Nacional de Neurología y Neurocirugía,
Central Luzon State University, Muñoz, Philippines Mexico, Mexico
xii Contributors to Volume 1

P Mendola CJC Phillips

Eunice Kennedy Shriver National Institute of Child University of Queensland, Gatton, QLD, Australia
Health and Human Development, Rockville, MD,
United States D Poli
Italian Workers’ Compensation Authority (INAIL),
Jerry R Miller Research Center at the University of Parma, Parma,
Western Carolina University, Cullowhee, NC, United Italy
States
Boris A Portnov
ZA Mohamed University of Haifa, Haifa, Israel
Department of Botany and Microbiology, Faculty of
Science, Sohag University, Sohag, Egypt SH Prankel
University of Worcester, Worcester, United Kingdom
Elmer-Rico E Mojica
Pace University, New York, NY, United States J Pronczuk
J Moya World Health Organization, Geneva, Switzerland
US Environmental Protection Agency, National Center Prasanthi Puvanachandra
for Environmental Assessment, Washington, DC, United Johns Hopkins Bloomberg School of Public Health,
States Baltimore, MD, United States
A Mutti
Mohammad Mahmudur Rahman
University of Parma, Parma, Italy
The University of Newcastle, Callaghan, NSW,
K Ndebele Australia
Jackson State University, Jackson, MS, United States
Md Harunur Rashid
Anastasia Nikolaou The University of Newcastle, Callaghan, NSW,
University of the Aegean, Mytilene, Greece Australia
Curtis W Noonan P Ravenscroft
The University of Montana, Missoula, MT, United States Entec UK Ltd, Cambridge, United Kingdom
Jerome Nriagu Lauren Reilly
University of Michigan, Ann Arbor, MI, United States Pace University, New York, NY, United States
TM O’Connor F Renaud
Mercy University Hospital, Cork, Ireland Ecologie, Génétique, Evolution et Contrôle (MIVEGEC),
R O’Handley Montpellier, France
School of Animal and Veterinary Sciences, The Renato G Reyes
University of Adelaide, SA, Australia Central Luzon State University, Muñoz, Philippines
Jasmin Omeragic GE Rice
Veterinary Faculty of the University of Sarajevo, United States Environmental Protection Agency,
Sarajevo, Bosnia and Herzegovina Cincinnati, OH, United States
AR Osornio-Vargas A Riecke
Department of Pediatrics, University of Alberta, Bundeswehr Institute of Radiobiology, University of
Edmonton, AB, Canada Ulm, Munich, Germany
Panagiota Panagiotaki Camilo Rios
University of Thessaly, Volos, Greece Instituto Nacional de Neurología y Neurocirugía,
Aniruddha B Pandit Mexico, Mexico
Institute of Chemical Technology, Matunga, Mumbai, CA Robledo
India University of Texas Rio Grande Valley, Harlingen, TX,
Jean C Pfau United States
Montana State University, Bozeman, MT, United States I Rosas
E Phelan Universidad Nacional Autónoma de México, México
Mercy University Hospital, Cork, Ireland D.F., Mexico
 Contributors to Volume 1 xiii

H-A Rother Hongzhe Sun

University of Cape Town, Cape Town, South Africa
CG Ruf
Bundeswehr Institute of Radiobiology, University of
Ulm, Munich, Germany
Paolo Sacco
Fondazione Salvatore MaugeridIRCCS, Padova, Italy
B Schoket
National Institute of Environmental Health, Budapest,
Hungary
Veronika Sele
National Institute of Nutrition and Seafood Research
(NIFES), Bergen, Norway
SG Selevan
Consultant, Silver Spring, MD, United States
J Settele
Helmholtz Centre for Environmental Research-UFZ,
Halle (Saale), Germany
Arun K Shanker
Indian Council of Agricultural Research (ICAR),
Hyderabad, India
DG Shendell
UMDNJ-School of Public Health, Piscataway, NJ,
United States
VW Sidel
Montefiore Medical Center and Albert Einstein College
of Medicine, Bronx, NY, United States; and Weill
Cornell Medical College, New York, NY, United States
J Sidhu
CSIRO Land and Water, Queensland Bioscience
Precinct, Brisbane, QLD, Australia
Sushant K Singh
Virtusa Corporation, Irvington, NJ, United States of
America
Sukesh Narayan Sinha
National Institute of Nutrition (ICMR), Hyderabad,
India
M Sliwinska-Kowalska
Nofer Institute of Occupational Medicine, Medical
University of Lodz, Lodz, Poland
Jens J Sloth
National Institute of Nutrition and Seafood Research
(NIFES), Bergen, Norway; and Technical University of
Denmark, Kongens Lyngby, Denmark
Alexander D Stein-Alexandrescu
San Diego, CA, United States
The University of Hong Kong, Hong Kong, People’s
Republic of China
K Takeda
Tokyo University of Science, Chiba, Japan
PB Tchounwou
Jackson State University, Jackson, MS, United States
LK Teuschler
United States Environmental Protection Agency,
Cincinnati, OH, United States
F Thomas
Ecologie, Génétique, Evolution et Contrôle (MIVEGEC),
Montpellier, France
S Tong
Shanghai Children’s Medical Center, Shanghai Jiao
Tong University, Shanghai, China; Anhui Medical
University, Hefei, China; and Queensland University of
Technology, Brisbane, QLD, Australia
S Toze
CSIRO Land and Water, Queensland Bioscience
Precinct, Brisbane, QLD, Australia
Andrew Turner
University of Plymouth, Plymouth, United Kingdom
M Umezawa
Tokyo University of Science, Chiba, Japan
JL Valdespino
Laboratorios de Biológicos y Reactivos de México,
Secretaria de Salud, Distrito Federal, Mexico
Cristina M Villanueva
ISGlobal - Barcelona Institute for Global Health,
Barcelona, Spain; Pompeu Frabra University, Barcelona,
Spain; CIBER Epidemiology and Public Health, Madrid,
Spain; and IMIM (Hospital del Mar Medical Research
Institute), Barcelona, Spain
Lionel F Villarroel
Western Carolina University, Cullowhee, NC, United
States
M Vittecoq
Centre de Recherche de la Tour du Valat, Arles, France;
and Ecologie, Génétique, Evolution et Contrôle
(MIVEGEC), Montpellier, France
JR Walton
University of New South Wales, Sydney, NSW,
Australia
Runming Wang
The University of Hong Kong, Hong Kong, People’s
Republic of China
xiv Contributors to Volume 1

Shuxiao Wang Ishwar C Yadav

Tsinghua University, Beijing, China
Ellen M Wells
Purdue University, West Lafayette, IN, United States
TJ Woodruff
University of California, San Francisco, San Francisco,
CA, United States
JM Wright
United States Environmental Protection Agency,
Cincinnati, OH, United States
Tokyo University of Agriculture and Technology
(TUAT), Fuchu-Shi, Tokyo, Japan
Laura Zaratin
Fondazione Salvatore MaugeridIRCCS, Padova, Italy
FB Zhan
Texas State University, San Marcos, TX, United States
Weiqi Zhou
State Key Laboratory of Urban and Regional Ecology,
Research Center for Eco-Environmental Sciences,
Chinese Academy of Sciences, Beijing, China
GUIDE TO USE THE ENCYCLOPEDIA

Structure of the Encyclopedia

The material in the Encyclopedia is arranged as a series of articles in alphabetical order.

There are four features to help you easily find the topic you are interested in: an alphabetical contents list, a subject classification
index, cross-references, and a full subject index.

Alphabetical Contents List

The alphabetical contents list, which appears at the front of each volume, lists the entries in the order that they appear in the Ency-
clopedia. It includes the page number of each entry.

Subject Classification Index

This index appears at the start of each volume and groups entries under subject headings that reflect the broad themes of Environ-
mental Health. This index is useful for making quick connections between entries in different volumes and locating the relevant
entry for a topic that is covered in more than one article.

Cross-References

All of the entries in the Encyclopedia have been extensively cross-referenced. The cross-references which appear at the end of each
entry serve three functions:
i. To indicate if a topic is discussed in greater detail elsewhere.
ii. To draw the readers’ attention to parallel discussions in other entries.
iii. To indicate material that broadens the discussion.

Example
The following list of cross-references appears at the end of the entry. Application of Healthy Life Year Measures to Environmental
Health Issues

See Also: Composite Measures of the Environmental Burden of Disease at the Global Level; Global Burden of Disease (GBD) Approach and the
Use of Disability Adjusted Life Years (DALY) at the World Health Organization (WHO); Quality of Life and Environmental Health Assessment; Use of
Years of Potential Life Lost (YPLL) for Risk Assessment at Hazardous Waste Sites.

Index

The index includes page numbers for quick reference to the information you are looking for. The index entries differentiate between
references to a whole entry, a part of an entry, or a table or figure.

Contributors

At the start of each volume there is a list of the authors who contributed to the relevant volume of the Encyclopedia.

xv
This page intentionally left blank
SUBJECT CLASSIFICATION (THEMATIC TABLE OF CONTENTS)

Air Pollution and Human Health

Air Pollution and Development of Children’s Pulmonary Function

Air Pollution and Lung Cancer Risks
Air Pollution From Solid Fuels
Assessment of Human Exposure to Air Pollution
Community Outdoor Air Quality: Sources, Exposure Agents, and Health Outcomes
Complex Air Pollution in China
Cyclic Volatile Methylsiloxanes: Occurrence and Exposure
Hazardous (Organic) Air Pollutants
Industrial Livestock Production Facilities: Airborne Emissions
Intercontinental Air Pollution Transport: Links to environmental health
Long-Range Transport and Deposition of Air Pollution
Long-Term Effects of Particulate Air Pollution on Human Health
Measurement of Air Pollutants
Mercury Emissions at Regional and Global Scale
Mercury in Air
Mobile Source Related Air Pollution: Effects on Health and the Environment
Mutagenicity of PM2.5
PM2.5 Sources and Their Effects on Human Health in China: Case Report
Pollen Allergens
Residential and Nonresidential Biomass Combustion: Impacts on Air Quality
Respiratory Effects of Short-Term Peak Exposures to Sulfur Dioxide
Short-Term Effects of Air Pollution on Health
Short-Term Effects of Particulate Air Pollution on Human Health
Sulfur Oxides

Assessment of Exposure to Environmental Risks (Methodologies)

Advances in Analytical Methods for the Determination of Pharmaceutical Residues in Waters and Wastewaters
Application of Healthy Life Year Measures to Environmental Health Issues
Bias in Environmental Epidemiology
Biomarkers in Environmental Carcinogenesis
Biomarkers of Environmental Exposures in Blood
Cumulative Environmental Risk
Dermal Exposures
Environmental Epidemiology
Environmental Health Tracking
Environmental Specimen Bank for Human Tissues
The Exposome: An Approach Toward a Comprehensive Study of Exposures in Disease
Exposure Guidelines and Radon Policy
Exposure Modeling and Measurement: Exposure Factors
Exposure Reconstruction using Space-Time Information Technology
Exposure Science: Contaminant Mixtures
Exposure Science: Ingestion
Exposure Science: Monitoring Environmental Contaminants

xvii
xviii Subject Classification (Thematic Table of Contents)

Exposure Science: Pharmacokinetic Modeling

Exposure Science: Routes of ExposuredInhalation
Frequency and Timing of Environmental Exposure
Global Measures of the Environmental Burden of Disease
Hair Elements for Biomonitoring of Human Exposure, Effects, and Health Hazards
How Hormesis Will Change the Risk Assessment Process
Methodologies for Assessing Bioaerosol Exposures
Methods for Estimating Exposure to Metals in Drinking Water
Pets as Sentinels of Human Exposure
Pharmacokinetic and Pharmacodynamic Considerations in Children’s Human Health Risk Assessment
Physiologically Based Pharmacokinetic Modeling and Risk Assessment
Physiologically Based Pharmacokinetic Modeling for Exposure and Risk Assessment
Toenails for Biomonitoring of Environmental Exposures
Tooth Biomarkers in Environmental Health Research
Toxicological Pathways of Relevance to Medical Geology
Waterborne Disease Surveillance

Children’s Health and Prenatal Exposures

Children’s Environmental Health: General Overview

Children’s Environmental Health in Developing Countries
Children’s Exposure to Environmental Agents
Children’s Health Risk Assessment: Issues and Approaches
Critical Windows of Children’s Development and Susceptibility to Environmental Toxins
Developmental and Reproductive Toxicity of TCDD, Lead, and Mercury
Developmental Immunotoxicants
Effect of Early Exposure on Reproductive Outcomes
Environmental Agents and Childhood Cancer
Environmental Chemicals in Breast Milk
Environmental Factors in Children’s Asthma and Respiratory Effects
Evidence for Endocrine Disruption in Children: Sensitive Developmental Endpoints
Issues and Challenges for Determining Environmental Risk Factors and Causes of Disease Among Children
Japan Environment and Children’s Study: Concept, Protocol, and Current Status
Malformations of Cortical Development and Epilepsy in Children
Mercury and Children Health
Pharmacokinetic and Pharmacodynamic Considerations in Children’s Human Health Risk Assessment
Prenatal Exposure to Industrial Chemicals and Pesticides and Effects on Neurodevelopment
Prenatal Exposure to Polycyclic Aromatic Hydrocarbons
Reproductive Effects of Oil-Related Environmental Pollutants

Climate Change and Human Health

Climate Change, Environmental Health, and Human Rights

Climate Change: Health Risks and Adaptive Strategies
Global Climate Changes and International Trade and Travel: Effects on Human Health Outcomes
Heat Wave and Mortality of the Elderly
Protozoan Waterborne Infections in the Context of the Actual Climatic Changes and Extreme Weather Events
Thermal Stress
Vector-Borne Disease and Climate Change
Weather, Pollen Concentrations, and Allergic Rhinitis

Country- and Area-Specific Environmental Health Issues

An Ecological Disaster Zone with Impact on Human Health: Aral Sea

Bahama Archipelago: Environment and Health
Briefing on Children Environmental Health in Uruguay
Bolivia: Mining, River Contamination, and Human Health
Cyanotoxins in Egypt and Saudi Arabia
 Subject Classification (Thematic Table of Contents) xix

Diabetes Mellitus in Albania: A Twofold Increase in the Last Decade

Environmental Conditions in the Estuarine Coast of Montevideo (Uruguay): Historical Aspects and Present Status: An Update
Environmental Health and Leishmaniasis by Indication on Afghanistan: A Review
Environmental Health Concerns in Cameroon
The Environmental Health of Children of Migrant WorkersdAn Example From China
Ghana: Ecology, Politics, Society, and Environmental Health
Human Tick-Borne Diseases in Southern Europe: Present Status and Future Challenges
Indonesia: Threats to the Country’s Biodiversity
Kuwait: Before and After the Gulf War
Lebanon: Health Valuation of Water Pollution at the Upper Litani River Basin
Leishmaniasis and Environment in Argentina: An Ecoepidemiological Approach
Malaria, Bilharzia, and Geohelminth Transmission in Kenya: Environmental Determinants
Malaysia: Environmental Health Issues
Mexican Epidemiological Paradox: A Developing Country with a Burden of “Richness” Diseases: An Update
Mozambique: Environment and Health in One of the World’s Poorest Nations
Mycotoxins and Public Health in Africa
Nigeria: Environmental Health Concerns
The Occurrence and Potential Health Risk of Microcystins in Drinking Water of Rural Areas in China
Oil Industry and the Health of Communities in the Niger Delta of Nigeria
PM2.5 Sources and Their Effects on Human Health in China: Case Report
Sandflies and Sandfly-Borne Zoonotic Infections in Greece
Sierra Leone: Environmental Health Concerns
Spain: Natural Hazards in the Country
Taiwan: Environmental Health Concerns
Tunisia: Water Resource Management and Sustainability of Agriculture
Waterborne Parasites in North African Environments
Water Environment Management in India

Dietary Exposures and Food Quality

Arsenic Exposure From Seafood Consumption

Bisphenol A
Blastocystis spp., Ubiquitous Parasites of Human, Animals, and Environment
Diet as a Healthy and Cost-Effective Instrument in Environmental Protection
Effects of Cooking on Dietary Exposure to Arsenic From Rice and Vegetables: Human Health Risks
Environmental Reservoirs of Antimicrobial Resistance of Foodborne Pathogens
Epigenetic Changes Induced by Environment and Diet in Cancer
Food Safety and Risk Analysis
Furfuryl AlcoholdA Food Additive
Mycotoxins in Foods
Mycotoxins in the Food Chain and Human Health Implications
Nutrition and CancerdAn Update on the Roles of Dietary Factors in the Etiology, Progression, and Management of Cancer
Pyridine
Vinylidene ChloridedUsed to Produce Flexible Films for Food Packaging

Disinfection By-products

Carcinogenicity of Disinfection Byproducts in Humans: Epidemiological Studies

Carcinogenicity of Disinfection Byproducts in Laboratory Animals
Empirical Models to Predict Disinfection By-Products(DBPs) in Drinking Water: An updated review
Genotoxicity of Disinfection By-Products: Comparison to Carcinogenicity
Respiratory Effects of Chlorination Products
Risks of Disinfection Byproducts in Drinking Water: Comparative Mammalian Cell Cytotoxicity and Genotoxicity

Disparities and Social Determinants of Environmental Health

Climate Change, Environmental Health, and Human Rights

Community Environmental and Health Needs: Novel Approaches and Methods
xx Subject Classification (Thematic Table of Contents)

The Definition of Refugees and Health Issues Related to Refugee Influx in Europe
The Environmental Health of Children of Migrant WorkersdAn Example From China
Environmental Justice and Interventions to Prevent Environmental Injustice in the United States
Environmental Justice: An International Perspective
Environmental Justice: An Overview
Gender Differences in Cancer Incidence
Health Impacts of Energy Poverty and Cold Indoor Temperature
Life Course Epidemiology and Inequality in Health
Maternal and Child Health Disparities: Environmental Contribution
Neighborhood Risk and Infant Health
Neighborhood “Social Infrastructure” for Health
Perceptions and Physiological Responses to Indoor Air Quality
Political and Social Violence: Health Effects
Social Coherence and Social Structure and Health
Social Environment: Overview
Social Support and Social Networks

Ecosystem Services and Human Health (Ecohealth)

Air Transportation and Human Health

Biodiversity and the Loss of Biodiversity Affecting Human Health
Biological Pathways between the Social Environment and Health
Carbon Farming
Desertification
Disabling Environments
Disentangling Physical, Chemical, Nutritional, and Social Environmental Influences on
Asthma Disparities: the Promise of the Exposome
Eco Health: Stratospheric Ozone
Entomological Risks of Genetically Engineered Crops
Environmental Health, Planetary Boundaries, and Limits to Growth
Floriculture
Forest Transition and Zoonoses Risk
Global Climate Changes and International Trade and Travel: Effects on Human Health Outcomes
Human Health and the State of the Pedosphere
Human Health Link to Invasive Species
The Impact of Environmental and Anthropogenic Factors on the Transmission Dynamics of Vector-Borne Diseases
Land Quality: Environmental and Human Health Effects
Landscape Epidemiology of Human Onchocerciasis in Southern Venezuela
Medical Anthropology
Mollusc Bivalves as Indicators of Contamination of Water Bodies by Protozoan Parasites
Oceans and Human Health
Overview of how Ecosystem Changes Can Affect Human Health
Parasite Zoonoses
Plants as a Tool for the Environmental Health Assessment
Principles of Medical Geology
Psychobiological Factors in Environmental Health
Small and Medium Enterprises: Barriers and Drivers of Managing Environmental and Occupational Health Risks
Small-Scale Industries and Informal Sector Activity Premises: Environmental and Occupational Health Issues
Sustainable Management of Agricultural Systems: Physical and Biological Aspects of Soil Health
UN Convention on Wetlands (RAMSAR): Implications for Human Health
UN Convention to Combat Desertification
Using Testate Amoebae Communities to Evaluate Environmental Stress: A Molecular Biology Perspective

Electromagnetic Fields

Electromagnetic Fields: Environmental Exposure

Electromagnetic Fields From Mobile Phones and Their Base Stations: Health Effects
 Subject Classification (Thematic Table of Contents) xxi

Low-Frequency Magnetic Fields: Potential Environmental Health Impacts

Radiofrequency Electromagnetic Fields: Health Effects

Emerging Environmental Contaminants

Nanomaterials in the Environment and their Health Effects

Nanomaterials: Potential Ecological Uses and Effects
Nanosilver: Environmental Health Effects
Perfluorooctanoic AciddA Water and Oil Repellent

Environmental Cancers

Air Pollution and Lung Cancer Risks

Benzene: Environmental Exposure
Biomarkers in Environmental Carcinogenesis
Cancer and the Environment: Mechanisms of Environmental Carcinogenesis (MS32)
Cancer Risk Assessment and Communication
Connecting Environmental Stress to Cancer Cell Biology through the Neuroendocrine Response
Environmental Agents and Childhood Cancer
Environmental Carcinogens and Regulation
Environmental Lung Cancer Epidemiology
Epigenetic Changes Induced by Environment and Diet in Cancer
Erionite Series Minerals: Mineralogic and Carcinogenetic Properties
Gene–Environment Interactions and Childhood Cancer
History of the Dose–Response
Human Health Implications of Personal Care Products: Breast Cancer and Other Breast-Related Diseases
Indoor Air Pollution Attributed to Solid Fuel use for Heating and Cooking and Cancer Risk
Mutagenicity of PM2.5
Nutrition and CancerdAn Update on the Roles of Dietary Factors in the Etiology, Progression, and Management of Cancer
Pesticide Exposure and Human Cancer

Environmental Health Economics (Cost–Benefit Analysis)

Cost–Benefit Analysis and Air Quality–Related Health Impacts: A European Perspective

Decision-Making Under Uncertainty: Trade-Offs between Environmental Health and Other Risks
Economic Analysis of Health Impacts in Developing Countries
Economic Valuation of Health Impacts in Cost–Benefit Analyses of Infrastructure Projects in Europe
Estimating Environmental Health Costs: Monetary Valuation of Greenhouse Gases
Estimating Environmental Health Costs: Valuation of Children’s Health Impacts
General Introduction to Valuation of Human Health Risks
Monetary Valuation of Health Impacts from Noise
Monetary Valuation of Trace Pollutants
Optimal Pollution: the Welfare Economic Approach to Correct Related Market Failures
Social Cost–Benefit Analysis of Air Pollution Control Measures at Industrial Point Emission Sources: Methodological
Overview and Guidance for the Assessment of Health-Related Damage Costs

Environmental Health Emergencies (Disasters)

1976 Trichlorophenol Reactor Explosion at Seveso, Italy

Bhopal Gas Catastrophe 1984: Causes and Consequences
Environmental Health and Bioterrorism
Floods as Human Health Risks
Fukushima Nuclear DisasterdEmergency response to the disaster
Fukushima Nuclear DisasterdMonitoring and Risk Assessment
Fukushima Nuclear Disaster: Multidimensional Psychosocial Issues and Challenges to Overcome Them
Human Health Effects of Landslides
xxii Subject Classification (Thematic Table of Contents)

Immunological Effects of the Chernobyl Accident

Natural DisastersdEnvironmental Health Preparedness
Natural DisastersdMental health Impacts
Oil and Chemical Spills
Other Environmental Health Issues: Oil Spill
Radiation Exposures due to the Chernobyl Accident
Road Traffic Injuries
Thyroid Cancer Associated with the Chernobyl Accident
Volcanic and geothermal processes: Health Effects
Volcanoes and Human Health
Volcanogenic Contaminants: Chronic Exposure

Environmental Health Management

Diet as a Healthy and Cost-Effective Instrument in Environmental Protection

Management and Export of Wastes: Human Health Implications
Noise Management: International Regulations
Risk Management in Environmental Health Decision
Sustainable Management of Agricultural Systems: Physical and Biological Aspects of Soil Health
Water Environment Management in India

Environmental Influence on Communicable Diseases

Biological Agents and Infectious Diseases in War and Terrorism

Biomass Smoke and Infection: Mechanisms of Interaction
Chagas Disease: Environmental Risk Factors
Cholera: Environmental Risk Factors
Cryptosporidiosis: An Update
Dampness and Mold Hypersensitivity Syndrome as an Umbrella for Many Chronic Diseases
Environmental Health Impacts on Ascariasis Infections by Indication of Afghanistan: A Review
Epidemiology of Infectious Diarrhea
Free-Living Amoebae and Their Multiple Impacts on Environmental Health
Hantavirus
Infectious Processes and Medical Geology
Landscape Epidemiology of Human Onchocerciasis in Southern Venezuela
Legionnaires’ Disease: Environmental Risk Factors
Leishmaniases
Lyme Disease
Lymphocystis Disease Virus in Aquatic Environment
Malaria as an Environmental Disease
Parasite Zoonoses
Past, Present, and Future of Malaria prevalence and Eradication in the Light of Climate Change
Protozoan Waterborne Infections in the Context of the Actual Climatic Changes and Extreme Weather Events
Severe Acute Respiratory Syndrome
Schistosomiasis
Shigellosis
Tuberculosis
Tuberculosis: Epidemiology and Global Impact, Including Extrapulmonary Tuberculosis Manifestation With Emphasis on
Skeletal Tuberculosis and a Rare Example of Shoulder Tuberculosis From Tibetan Plateau Area
Vermamoeba vermiformisdGlobal Trend and Future Perspective
West Nile Virus
Zika Virus: A Compendium of the State of Knowledge

Ethics in Environmental Health Research and Practice

Environmental Health Ethics in the Study of Children

Ethics in Pediatric Environmental Health Research
 Subject Classification (Thematic Table of Contents) xxiii

Objectivity and Ethics in Environmental Health Science

War and Environmental Health: Chemical Warfare Agents

Gene–Environment Interactions

Biomarkers of Disease and Genetic Susceptibility

Developmental Programming and the Epigenome
Entomological Risks of Genetically Engineered Crops
Epigenetic Changes Induced by Environment and Diet in Cancer
Epigenetic Effects of Nanomaterials
Epigenetics of Environmental Exposures
Fish and Genes: From Marine Ecology to Applied Hydrobiology and Beyond
Functional Genomics and Molecular Analysis of a Subtropical Harmful Algal Bloom Species
Gene–Environment Interactions and Childhood Cancer
Gene–Environment Interactions in Neurodegenerative Diseases
Genetically Modified Plants: Risks to Environment
Genetics is Involved in Everything, but not Everything is Genetic
Genome-Based Drug Design
Genome Effects and Mutational Risk of Radiation
Labeling of Genetically Modified Foods
Polymorphism and Gene–Environment Interactions in Environmental Cancer
Stress Axis as the Locus of Gene–Environment Interactions in Major Depressive Disorder

Globalization and Environmental Health

Asthma: Environmental and Occupational Risk Factors

Avian Influenza Viruses
Global Development and Population Health
Globalization and Environmental Health
Global Life Cycle Impacts of Consumer Products
Global Measures of the Environmental Burden of Disease
Health Issues of Travelers
International Environmental Agreements and Environmental Health
Trade, Trade Agreements, and the Environment

Guidelines and Regulations

Air Quality Legislation

Boron: Environmental Exposure and Human Health
Environmental Carcinogens and Regulation
Gallium: Environmental Pollution and Health Effects
Genetically Modified Organisms
Germanium: Environmental Pollution and Health Effects
Health, Exposure, and Regulatory Implications of Nitrate and Nitrite in Drinking Water
International Environmental Agreements and Environmental Health
Iodine in the Environment
Noise Management: International Regulations
Noise Management: Soundscape Approach
Palladium: Exposure, Uses, and Human Health Effects
Platinum: Environmental Pollution and Health Effects
Policy Responses to Climate Change
Soil Quality Criteria for Environmental Pollutants
Thallium: Environmental Pollution and Health Effects
Trade, Trade Agreements, and the Environment
Uranium: Environmental Pollution and Health Effects
xxiv Subject Classification (Thematic Table of Contents)

Vanadium: Environmental Pollution and Health Effects

Worldwide Regulatory Strategies and Policies for Drinking Water

Historical Aspects

Environmental Health: An Overview on the Evolution of the Concept and Its Definitions
Environmental Pollution and Human Health in Ancient Times
History of the Dose–Response
Occupational Cancer: Modern History

Household Products: Health Risks

1,2-DichloropropanedA Paint Stripper and Dry-Cleaning Component

1,3-Propane SultonedA Common Additive for Detergents and Emulsifiers
1-tert-Butoxypropan-2-oldA Component of Commercial Cleaner Formulations
Beta-MyrcenedA Fragrance and Flavoring Agent
Bisphenol A
DichloromethanedA Paint Stripper and Plastic Welding Adhesive
Housing-related health Hazards: Assessment and Remediation
Perfluorinated Substances
Perfluorooctanoic AciddA Water and Oil Repellent
Phthalates: Exposure and Health Effects
Phthalates: Occurrence and Human exposure
TetrafluoroethylenedFor Production of Teflon, Fluoroplastics, and Fluoroelastomers
TetrahydrofurandUsed to Manufacture Most Elastomeric Polyurethanes

Hydraulic Fracking

Hydraulic Fracturing and Public Health

Indoor Air Pollution: Health Effects

Assessing Indoor Air Quality

Bioaerosols in Apartment Buildings
Chronic Obstructive Pulmonary Disease
Cockroach Allergens: Exposure Risk and Health Effects
Dust Production Following Forest Disturbances: Health Risks
Gene–Environment Interactions: Cigarette Smoke, APC, DNA Damage Repair, and Human Health
Indoor Air Pollution Attributed to Solid Fuel use for Heating and Cooking and Cancer Risk
Indoor Air Pollution: Unusual Sources
Indoor Radon Prevention and Mitigation
Inhaled Woodsmoke
Particulate Matter and Ultrafine Particles in Indoor Air
Perceptions and Physiological Responses to Indoor Air Quality
Productivity and Health Effects of High Indoor Air Quality
Radon: An Overview of Health Effects
Residential Radon Levels Around the World
Ventilation

Ionizing and Nonionizing Radiation: Health Effects

Clinical Consequences of Radiation Exposure

Electromagnetic Fields: Environmental Exposure
Electromagnetic Fields From Mobile Phones and Their Base Stations: Health Effects
Microwaves: Exposure and Potential Health Consequences
 Subject Classification (Thematic Table of Contents) xxv

New Molecular Aspects of Ultraviolet-Induced Immunosuppression

Nuclear Energy and Human Health
Psychological and Mental Health Aspects of Ionizing Radiation Exposure
Radiofrequency Electromagnetic Fields: Health Effects
Retrospective Dosimetry and Dose Reconstruction of Ionizing Radiation
Risk of Radiation Exposure to Children and Their Mothers
Ultraviolet Exposure: Health Effects
Ultraviolet: Ocular Effects
Ultraviolet Radiation and the Skin
Ultraviolet Radiation Protection

Measures of Community Disease Burden

Application of Healthy Life Year Measures to Environmental Health Issues

Global Burden of Disease approach and the use of Disability-Adjusted Life Years at the World Health Organization
Global Measures of the Environmental Burden of Disease
Quality of Life and Environmental Health Assessment
YPLL: A Comprehensive Quantitative Tool to Evaluate Worker Risk Under Green and Sustainable Remediation

Metals/Metalloids: Environmental Exposure and Health Effects

Arsenic: Occurrence in Groundwater

Arsenic Pollution of Groundwater in Bangladesh
Beryllium: Environmental Geochemistry and Health Effects
Bioavailable Aluminum: Its Effects on Human Health
Bioavailable Aluminum: Its Metabolism and Effects on the Environment
Bismuth: Environmental Pollution and Health Effects
Cadmium and the Welfare of Animals
Cadmium Exposure in the Environment: Dietary Exposure, Bioavailability, and Renal Effects
Cadmium Neurotoxicity
Chromium VI Toxicology
Chromium: Environmental Pollution, Health Effects, and Mode of Action
Dental Amalgam Fillings: An Underinvestigated Source of Mercury Exposure
Depleted Uranium: Exposure and Possible Health Effects
Drosophila as a Model for Toxicogenomics of Lead
Environmental and Health Consequences of Nuclear, Radiological, and Depleted Uranium Weapons
The Export of Hazardous Industries
Gold and Amalgams: Environmental Pollution and Health Effects
Itai-itai Disease
Lead and Attention-Deficit Hyperactivity Disorder
Lead, Delinquency, and Criminal Offending
Lead Exposure and Caries in Children
Lithium: Environmental Pollution and Health Effects
Magnesium and Calcium in Drinking Water and Heart Diseases
Manganese: Environmental Pollution and Health Effects
Mercury and Children Health
Mercury Toxicity
Minamata Disease
Molybdenum in the Environment and its Relevance for Animal and Human Health
Nanoscale Titanium Dioxide: Environmental Health and Ecotoxicological Effects
Overview of Potential Aluminum Health Risks
Plutonium: Environmental Pollution and Health Effects
Renal and Neurological Effects of Heavy Metals in the Environment
Strontium in the Environment and Possible Human Health Effects
Tin: Environmental Pollution and Health Effects
Tungsten: Environmental Pollution and Health Effects
Uranium: Toxicity to Renal Cells and Osteoblasts
Water Consumption and Implications for Exposure Assessment
xxvi Subject Classification (Thematic Table of Contents)

Zinc Deficiency in Human Health

Zinc Toxicity in Humans

Noise Pollution: Exposure and Health Effects

Cardiovascular Effects of Noise

Combined Exposures to Noise and Chemicals at Work
Combined Transportation Noise Exposure in Residential Areas
Effects of Low-Frequency Noise and Vibrations: Environmental and Occupational Perspectives
Environmental noise
Expressing the Significance of Environmental Exposures in Disability-Adjusted Life Years: The Right Answer to Wrong Questions?
Measuring Noise for Health Impact Assessment
Mental Health Effects of Noise
Noise and Cognition in Children
Noise and Health: Annoyance and Interference
Noise Management: International Regulations
Noise Management: Soundscape Approach
Sleep Disturbance in Adults by Noise

Outdoor Air Pollution: Health Effects

Air Pollution Episodes

Ambient Concentrations of Acrolein: Health Risks
Animal and Human Waste as Components of Urban Dust Pollution: Health Implications
Antarctic: Persistent Organic Pollutants and Environmental Health in the Region
Automobile Exhaust: Detrimental Effects on Pulmonary and Extrapulmonary Tissues and Offspring
Biomass Burning, Regional Air Quality, and Climate Change
Chronic Obstructive Pulmonary Disease
Eco Health: Stratospheric Ozone
Risk to Populations Exposed from Atmospheric Testing and Those Residing Near Nuclear Facilities
Vehicular Exhausts

Persistent Organic Pollutants

Dioxins
Dioxins: Health Effects
Estrogenic Chemicals and Cardiovascular Disease
Polychlorinated Biphenyls
Persistent Organohalogen Pollutants and Phthalates: Effects on Male Reproductive Function
Prenatal Exposure to Polycyclic Aromatic Hydrocarbons

Personal Care Products and Pharmaceuticals

Diethylstilbestrol Exposure in Mothers and Offspring

Human Health Implications of Personal Care Products: Breast Cancer and Other Breast-Related Diseases
Natural Health Products
Pharmaceuticals: Environmental Effects

Pesticides: Human Exposure and Toxicity

Challenges in Pesticide Risk Communication

DiazinondAn Insecticide
GlyphosatedA Herbicide
Insect Repellents: Assessment of Health Risks
Malathion
Organochlorines and the Effect on Female Reproductive System
 Subject Classification (Thematic Table of Contents) xxvii

Organophosphate Insecticides: Neurodevelopmental Effects

ParathiondAn Insecticide
Pesticide Exposure and Diabetes
Pesticide Exposure and Human Cancer
Pesticides: Human Health Effects
Prenatal Exposure to Industrial Chemicals and Pesticides and Effects on Neurodevelopment
Pyrethroid Insecticides: An Update
Take-Home Route of Pesticide Exposure
TetrachlorvinphosdAn Insecticide

Pollution-Specific Sources and Human Health

Dust Production Following Forest Disturbances: Health risks

Environmental Health Issues for Railroads
Environmental Risks associated with Waste Electrical and Electronic Equipment recycling plants
Mineral and Fuel Extraction: Health Consequences
Mining Activities: Health Impacts
Mobile Source–Related Air Pollution: Effects on Health and the Environment
Nuclear Energy and Human Health
Power Generation and Human Health
Shooting Ranges: Environmental Contamination
Sick Building Syndrome
Solid Fuel: Health Effects
Solid Fuel Use: Health Effect
Solid Waste Incinerators: Health Impacts
Volcanogenic Contaminants: Chronic Exposure

Recent Technological Advancements in Environmental Health Sciences

Biotechnology and Advances in Environmental Health Research

Diffusive Gradients in Thin Films: an Effective and Simple Tool for Assessing Contaminant
Bioavailability in Waters, Soils, and Sediments
Environmental Health Engineering: Rationale, Technologies, and Practices for Various Needs
Household Energy Solutions in Low- and Middle-Income Countries
Household Water Treatment and Safe Storage in Low-Income Countries

Soil/Dust Exposure

Antibiotics Pollution in Soil and Water: Potential Ecological and Human Health Issues
Bioaccessibility of Trace Metals in Household Dust
Contamination of Soil and Vegetation with Developing Forms of Parasites
Groundwater and Soil Pollution: Bioremediation
Impact of Natural Dusts on Human Health

Target Organ Toxicity of Environmental Pollutants

Asbestos Exposure and Autoimmune Disease

Cadmium Exposure in the Environment: Dietary Exposure, Bioavailability, and Renal Effects
Cadmium Neurotoxicity
Cardiotoxicity
Cardiovascular Effects of Noise
Chemically Induced Respiratory Toxicities
Developmental and Reproductive Toxicity of TCDD, Lead, and Mercury
Environmental Liver Toxins
Mechanisms of Immune Modulation by Xenobiotics
Metal-Induced Toxicologic Pathology: Human Exposure and Risk Assessment
Neurodevelopmental Toxicants
xxviii Subject Classification (Thematic Table of Contents)

Neurotoxicology
New Molecular Aspects of Ultraviolet-induced Immunosuppression
Organochlorines and the Effect on Female Reproductive System
Organophosphate Insecticides: Neurodevelopmental Effects
Oxidation–Antioxidation–Reduction Processes in the Cell: Impacts of Environmental Pollution
Renal and Neurological Effects of Heavy Metals in the Environment
Splenic Toxicology
Stress Axis as the Locus of Gene–Environment Interactions in Major Depressive Disorder

Urban Environment and Human Health

Built Environment and Mental Health

Physical Infrastructure Service and Environmental Health Deficiencies in Urban and Peri-urban Areas
Urban Environments and Health
Urban Health
Urban Health Indicators: The Role of Data Disparities
Urban Planning, the Natural Environment, and Public Health
Urban Transportation and Human Health

Waste, Wastewater, Sludge, and Human Health

Agro-Industrial Waste Conversion into Medicinal Mushroom Cultivation

Biosolids: Human Health Impacts
Electronic Waste and Human Health
Infectious/Medical/Hospital Waste: General Characteristics
Management and Export of Wastes: Human Health Implications
Microbial Risks Associated with Biogas and Biodigestor Sludge

Water Quality and Quantity

Antibiotics Pollution in Soil and Water: Potential Ecological and Human Health Issues
Aquatic Environment and Fish Welfare in Aquaculture
Arsenic: Occurrence in Groundwater
Arsenic Pollution of Groundwater in Bangladesh
Blastocystis spp., Ubiquitous Parasites of Human, Animals, and Environment
Clean Water for Developing Countries: Feasibility of Different Treatment Solutions
Drinking Water: Nitrate and Health
Drinking Water Treatment and Distribution Systems: Their Role in Reducing Risks and Protecting Public Health
Effects of Iodine and Fluorine in Drinking Water on Human Health
Essential Nature of Water for Health: Water as Part of the Dietary Intake for Nutrients and the Role of Water in Hygiene
Fluoride in Drinking Water: Effect on Liver and Kidney Function
Fluorine: Human Health Risks
Fluorosis
Giardia and Cryptosporidium: Occurrence in Water Supplies
Groundwater and Soil Pollution: Bioremediation
Heterotrophic bacteria in Bottled Water
Microbes and Water Quality in Developed Countries
Microorganisms in Beach Sand: What do we Still not Know?
The Occurrence and Potential Health Risk of Microcystins in drinking Water of Rural Areas in China
Particulate Matter and Public Health
Perfluorooctanoic AciddA Water and Oil Repellent
Recreational Exposure to Cyanobacteria
Sanitation in Low- and Middle-Income Countries
Shared Water Conflicts
Status of Water Resources and Human Health in the Middle East and North African Region: An Integrated Perspective
CONTENTS OF VOLUME 1

Preface xxxv

Advances in Analytical Methods for the Determination of Pharmaceutical Residues in Waters

and Wastewaters 1
Despo Fatta-Kassinos, Anastasia Nikolaou, and Lida Ioannou-Ttofa
Agro-Industrial Waste Conversion Into Medicinal Mushroom Cultivation 13
Arianne V Julian, Renato G Reyes, and Fumio Eguchi
Air Pollution and Development of Children’s Pulmonary Function 21
Jonathan Dubnov, Boris A Portnov, and Micha Barchana
Air Pollution and Lung Cancer Risks 29
Shuxiao Wang and Shuchang Liu
Air Pollution Episodes 41
P Brimblecombe
Air Pollution From Solid Fuels 49
Sukesh Narayan Sinha
Air Quality Legislation 61
A Fino
Air Transportation and Human Health 71
BS Cohen and AL Bronzaft
Ambient Concentrations of Acrolein: Health Risks 82
TJ Woodruff and DA Axelrad
An Ecological Disaster Zone with Impact on Human Health: Aral Sea 87
L Erdinger, H Hollert, and P Eckl
Animal and Human Waste as Components of Urban Dust Pollution: Health Implications 95
I Rosas, CF Amábile-Cuevas, E Calva, and AR Osornio-Vargas
Antarctic: Persistent Organic Pollutants and Environmental Health in the Region 103
Simonetta Corsolini
Antibiotics Pollution in Soil and Water: Potential Ecological and Human Health Issues 118
Hillary Jufer, Lauren Reilly, and Elmer-Rico E Mojica

xxix
xxx Contents of Volume 1

Application of Healthy Life Year Measures to Environmental Health Issues 132

Prasanthi Puvanachandra and Adnan A Hyder
Aquatic Environment and Fish Welfare in Aquaculture 143
Panagiota Panagiotaki and Emmanuil E Malandrakis
Arsenic Exposure From Seafood Consumption 147
Heidi Amlund, Veronika Sele, and Jens J Sloth
Arsenic: Occurrence in Groundwater 153
Dipankar Chakrabarti, Sushant K Singh, Md Harunur Rashid, and Mohammad Mahmudur Rahman
Arsenic Pollution of Groundwater in Bangladesh 169
P Ravenscroft
Asbestos Exposure and Autoimmune Disease 181
Jean C Pfau and Curtis W Noonan
Assessing Indoor Air Quality 191
S-O Baek
Assessment of Human Exposure to Air Pollution 199
Claudio Cocheo, Paolo Sacco, and Laura Zaratin
Asthma: Environmental and Occupational Risk Factors 207
Chi-Hsien Chen and Yue L Guo
Automobile Exhaust: Detrimental Effects on Pulmonary and Extrapulmonary Tissues and Offspring 217
M Umezawa and K Takeda
Avian Influenza Viruses 223
M Vittecoq, F Thomas, F Renaud, and M Gauthier-Clerc
Bahama Archipelago: Environment and Health 231
Françoise G Bourrouilh-Le Jan
Benzene: Environmental Exposure 252
D Poli, R Andreoli, A Mutti, EC Alexopoulos, EB Bakeas, and M Goldoni
Beryllium: Environmental Geochemistry and Health Effects 262
WM Edmunds
Bhopal Gas Catastrophe 1984: Causes and Consequences 272
Ingrid Eckerman
Bias in Environmental Epidemiology 288
Alexander P Keil and Jessie K Edwards
Bioaccessibility of Trace Metals in Household Dust 301
Andrew Turner
Bioaerosols in Apartment Buildings 307
Wan-Kuen Jo
Bioavailable Aluminum: Its Effects on Human Health 315
JR Walton
Bioavailable Aluminum: Its Metabolism and Effects on the Environment 328
JR Walton
 Contents of Volume 1 xxxi

Biodiversity and the Loss of Biodiversity Affecting Human Health 340

VC Hammen and J Settele
Biological Agents and Infectious Diseases in War and Terrorism 351
BS Levy and VW Sidel
Biological Pathways Between the Social Environment and Health 359
C Hertzman
Biomarkers in Environmental Carcinogenesis 366
B Schoket
Biomarkers of Environmental Exposures in Blood 376
Lesa L Aylward
Biomass Burning, Regional Air Quality, and Climate Change 386
Ishwar C Yadav and Ningombam L Devi
Biomass Smoke and Infection: Mechanisms of Interaction 392
J Grigg
Biosolids: Human Health Impacts 397
S Toze and J Sidhu
Biotechnology and Advances Environmental Health Research 405
PB Tchounwou and K Ndebele
Bismuth: Environmental Pollution and Health Effects 415
Runming Wang, Hongyan Li, and Hongzhe Sun
Bisphenol A 424
Ellen M Wells
Blastocystis spp., Ubiquitous Parasite of Human, Animals and Environment 429
Shahira A Ahmed and Panagiotis Karanis
Bolivia: Mining, River Contamination, and Human Health 436
Jerry R Miller and Lionel F Villarroel
Boron: Environmental Exposure and Human Health 456
M Korkmaz
Briefing on Children Environmental Health in Uruguay 460
Moll Maria José and Laborde Amalia
The Built Environment and Mental Health 465
Kim T Ferguson and Gary W Evans
Cadmium and the Welfare of Animals 470
CJC Phillips and SH Prankel
Cadmium Exposure in the Environment: Dietary Exposure, Bioavailability and Renal Effects 475
A Åkesson and Rufus L Chaney
Cadmium Neurotoxicity 485
Camilo Rios and Marisela Méndez-Armenta
Cancer and the Environment: Mechanisms of Environmental Carcinogenesis 492
P Irigaray and D Belpomme
xxxii Contents of Volume 1

Cancer Risk Assessment and Communication 503

Stacey A Fedewa
Carbon Farming 509
Jerome Nriagu
Carcinogenicity of Disinfection Byproducts in Humans: Epidemiological Studies 517
Cristina M Villanueva
Carcinogenicity of Disinfection Byproducts in Laboratory Animals 528
RL Melnick and MJ Hooth
Cardiotoxicity 535
Aurelian Bidulescu, Alexander D Stein-Alexandrescu, and Steven R Horbal
Cardiovascular Effects of Noise 543
W Babisch
Chagas Disease: Environmental Risk Factors 553
EJ Hanford and FB Zhan
Challenges in Pesticide Risk Communication 566
H-A Rother
Chemically-Induced Respiratory Toxicities 577
P-G Forkert
Children’s Environmental Health: General Overview 589
LR Goldman
Children’s Environmental Health in Developing Countries 593
J Pronczuk, M-N Bruné, and F Gore
Children’s Exposure to Environmental Agents 603
J Moya and LR Goldman
Children’s Health Risk Assessment: Issues and Approaches 610
S Barone, Jr and B Foos
Cholera: Environmental Risk Factors 616
JL Valdespino and L García-García
Chromium: Environmental Pollution, Health Effects and Mode of Action 624
Arun K Shanker
Chronic Obstructive Pulmonary Disease 634
A El-Gammal, E Phelan, and TM O’Connor
Clean Water for Developing Countries: Feasibility of Different Treatment Solutions 643
Shankar B Kausley, Gaurav G Dastane, Jyoti K Kumar, Ketan S Desai, Sarjerao B Doltade,
and Aniruddha B Pandit
Climate Change, Environmental Health, and Human Rights 653
C Carlarne and MH Depledge
Climate Change: Health Risks and Adaptive Strategies 661
S Tong and K Ebi
Clinical Consequences of Radiation Exposure 670
CG Ruf, A Riecke, and V Meineke
 Contents of Volume 1 xxxiii

Cockroach Allergens: Exposure Risk and Health Effects 678

RD Cohn
Combined Exposures to Noise and Chemicals at Work 686
M Sliwinska-Kowalska
Combined Transportation Noise Exposure in Residential Areas 695
Peter Lercher
Community Outdoor Air Quality: Sources, Exposure Agents and Health Outcomes 713
DG Shendell
Complex Air Pollution in China 728
Lijian Han and Weiqi Zhou
Connecting Environmental Stress to Cancer Cell Biology Through the Neuroendocrine Response 735
A Melhem and S Conzen
Contamination of Soil and Vegetation With Developing Forms of Parasites 742
Jasmin Omeragic and Teufik Goletic
Cost-Benefit Analysis and Air Quality Related Health Impacts: A European Perspective 755
Mike Holland
Critical Windows of Children’s Development and Susceptibility to Environmental Toxins 767
CA Robledo, P Mendola, and SG Selevan
Cryptosporidiosis: An Update 781
T Geurden and R O’Handley
Cumulative Environmental Risk 789
JC Lambert, LK Teuschler, GE Rice, JM Wright, and JC Lipscomb
Cyanotoxins in Egypt and Saudi Arabia 796
ZA Mohamed
Cyclic Volatile Methylsiloxanes: Occurrence and Exposure 805
Hermann Fromme
This page intentionally left blank
PREFACE

We live in a time of tumultuous change in which economic interdependence is increasing rapidly, information
technology is accelerating the spread of ideas, human influence on natural cycles and processes has become
evident on a global scale, and the spread of an infectious disease around the globe is only a plane ride journey
away. This process of interlocking economic, social, technological, political, and cultural changes that have
emerged around the world has been called globalization, a phenomenon that is shrinking space and increasing
the speed of interaction, changing our views of the world and of ourselves, and breaking down national and
cultural barriers. Globalization and collateral human activities are now transforming the Earth’s natural systems
in ways that are profound, pervasive, and accelerating. The transformational forces associated with rise of
human population to 7 billion people, rapid growth in per capita consumption of goods and services, and
oversized footprints of human activities on ecosystems have resulted in major changes of the planet’s land
cover, rivers and oceans, climate system, and biogeochemical cycles and generate vast amounts of industrial and
human wastes that are voided into the air, water, and land. Ecosystem services on which life on the Earth
depends are increasingly being jeopardized as the environment is modified to suit human needs. Never before
in the history of the Earth have the activities of a single species ever threatened the well-being of the entire
planet.
Environmental Health emerged as a scientific discipline in response to the need for systematic and
comprehensive approach to understanding the health impacts of human–environment interactions so as to
better inform decision-making in the land-use planning, environmental conservation, and public health
protection. First reports on the connections between ecosystemic change and human health outcomes can be
traced back to ancient timesdin Western societies to Hippocrates who wrote On Airs, Waters, and Places, and to
much earlier eras in Eastern societies. Historically, however, environmental health as a scientific discipline has
increasingly been focused on quantifying the exposure–response relationships for contaminants encountered in
human-dominated environment: from heavy metals, radiation to multitudes of organic pollutants. With this
framework, Environmental Health was defined as the study of health problems that are related to environmental
exposures and transcend national boundaries, with a goal of improving health for all people by reducing the environmental
exposures that lead to avoidable disease, disabilities and deaths (https://www.niehs.nih.gov/research/programs/geh/
index.cfm). In my view, this definition captures but one dimension of the human–environment relationships.
The development of the field under such epistemological framing has tended to be limited, segmented, and
incomplete. This was due to the fact that for some threats, it may be possible to establish clear causal linkages
and effects, but where the health hazard is the result of environmental change, the risk bundles are likely to
embrace interactions among streams of fundamental human processes including public policies, economic
activities, technological applications, and varying lifestyles. Dealing with environmental risks invariably
involves coping with the uncertain, the unknowable, and the inherently indeterminable. The situation is not
helped by the fact that mechanisms relating developmental hazards, environmental exposures, and health are
generally lacking and integrated databases and information systems to support policy and decision-making,
planning, and evaluation are rarely available at relevant spatial and timescales. A lot of the environmental
health programs and policies of recent decades have therefore been driven by political expediency, scientific
weight of evidence, or precautionary principles rather than based on sound scientific principles. The bio-
medically driven paradigm of environmental health, however, was a useful and pragmatic framework for
identifying and quantifying risks to human health in the environment so that the threats can be addressed.
Removing lead from gasoline worldwide and the Clean Air Act and Clean Water Act in the law books of most
countries are among the prominent successes of such paradigm.

xxxv
xxxvi Preface

Recent concepts of environmental health posit that epidemiological dynamics and actions of stakeholders
that determine the health of human (and animal) populations need to be studied in their interconnected
ecological, socioeconomic, and political contexts. They emphasize the importance of participatory, whole-
system approaches to understanding and promoting health and well-being in the context of social and
ecological interactions. What differentiates these approaches from earlier frameworks is the increased recog-
nition of the linkages between ecosystem health and human well-being, defined as covering physical,
psychological, and social aspects of wellness, and includes the presence of positive emotions and moods (e.g.,
contentment, happiness), and the absence of negative emotions (e.g., depression, anxiety), satisfaction with life,
fulfillment, resilience, and positive functioning. The new paradigm also values social and citizen dimensions
and believes that issues of equity (gender, socioeconomic classes, age, and even species) and research-to-action
are important to fully understand and resolve environmental health problems.
The relatively new branch of environmental health embodied in this encyclopedia places increased emphasis
on the impacts of changes in the structure and function of natural and human-dominated systems on health
outcomes at both the individual and population levels. It evolved from studies that repeatedly show that
degrading nature comes with several costs to the human population through loss of “ecosystem services” (health
benefits that ecosystems provide). Major impetus for the new concepts came from the United Nations (UN)
Conference on the Human Environment held in Stockholm in 1972 which placed human health in the context
of larger environmental processesdlifted environmental health out of the shadows of sanitary sciences and
“community” health. The subsequent UN Conference on Environment and Development (UNCED) held in Rio
de Janeiro in 1992 was remarkable in recognizing the importance of link between healthy people and healthy
environment as a prerequisite to sustainable development. The first principle of the Rio Declaration proclaimed
that “human beings are at the center of concerns for sustainable development. They are entitled to a healthy and
productive life in harmony with nature.” The implied notion that environmental health is a basic human right is
increasingly being embraced by governments in various parts of the world. The UNCED concretized the fact that
people everywhere are beginning to view the world they live in a more restrained, less belligerent, and more
realistic way. People in the environmental movement have come to realize that life without industries in
modern world is impossible while business leaders no longer have to be told that environmental stewardship
on their part has economic benefits and is good for customer relations. As many developing countries
increasingly emphasize the benefits of environmental regulations and controls in their march to industrialized
nation status, the less developed nations now look to them for leadership and are beginning to emulate their
growing environmental awareness and concerns. By the end of the 20th century, the links between environment,
health, and development had become a matter of interest and concern in most nations, both developed and
developing. By the time of the World Summit on Sustainable Development was held in Johannesburg in 2002,
achieving sustainable environmental health had become a “high table” goal in international affairs and a feature
item on many local, regional, and national socioeconomic agendas. The World Congress on Sustainable
Development of 2012 (often referred to as Rioþ20) and the subsequent UN Agenda for Sustainable Devel-
opment of 2015 further concretized ecosystem changes as a necessary adjunct of human health and well-being.
The benefits that people get from their environment (ecosystem services) have been categorized into four
types: provisioning services, such as food, fiber, and genetic resources; regulating services, such as water and air
quality; supporting services, such as primary production, water, and nutrient cycling; and cultural services, such
as recreation and religious sites. According to this typology, knowledge of ecosystem services perspective can
inform strategies for identifying and addressing health disparities among socioeconomic and racial/ethnic
groups who depend heavily on natural resources. It is well documented that (i) the critical determinants of
environmental health in many countries are increasingly global and outside the responsibility of individual
nations, and (ii) huge disparities persist in the morbidity and mortality between the developed and less
developed nations, due primarily to close interlocking of environmental risks and poverty. Poverty hinders the
development of clean water and proper sanitation; drives the migration into overcrowded cities with
substandard housing and high air pollution levels; is related to indoor air pollution from burning of biofuels or
urban solid wastes; increases exposure to intentional and unintentional injuries and the risk of lead poisoning;
and is primarily responsible for undernutrition with far-reaching effects. Transboundary movement of health
hazards from the developed countries, including polluting industries and industrial wastes, pesticides, heavy
and inefficient use of energy, and plundering of natural resources and spoliation of the environment, adds to
existing environmental risk factors in many communities especially in the developing countries. The realization
that ecosystem services are linked to health gains and economic growth is now beginning to shape national and
global policies that bear directly on environment and health interdependence.
 Preface xxxvii

Current inequities and human vulnerability in sub-Saharan Africa illustrate some of the challenges facing
human populations with degraded ecosystem services. The poverty of most sub-Saharan African countries and
their total dependence on nature’s goods and services for livelihood increase and extend their vulnerability to
environmental change and risks from new technologies. The “winds of change” that began in Africa in the 1960s
seem to have worsened the poverty level and both the environment and human capitals have continued on
a downward spiral, making the health of the population more susceptible to environmental risk factors. Over
60% of the population lives in ecologically vulnerable areas characterized by a high degree of sensitivity and low
degree of resilience. Rapid population growth and overexploitation of natural resources, deepening poverty, and
increasing food insecurity have brought about environmental changes that have taken a toll on the public’s
health. Mismanagement of natural resources, the impacts of disasters and civil strife, and response to external
pressures (such as the economic adjustment plans) have decimated the ecosystem services and exacerbated the
environmental health risks in the region. Other factors such as weak institutional and legal frameworks,
corruption, and poor economic performance have left most countries in the region with limited choices and low
coping capacity to deal with any environmental threats. It is easy to see why the highest rates of environmentally
attributable diseases are concentrated in this part of our world and where the need for environmental health
research is most desirable.
This brings us to the fundamental question: What is the definition of Environmental Health (EH)? As a field of
academic pursuit, environmental health is an outgrowth of the global environmental movement and straddles
the traditional disciplines of public health and environmental protection. In practice, it involves relevant
elements of ecology, conservation, economics, human behavior, ethics, and genomics. As a consequence, the
scientific literature is smattered with varying definitions of environmental health colored by the author’s own
disciplinary perspectives. Those who have been willing to move beyond their own academic domain would not
disagree with a definition of environmental health as the theory and practice of assessing, correcting, controlling,
managing and preventing the physical, chemical, biological, social and psychosocial factors in the environment that can
adversely affect human health including quality of life. The broad definition comes from the fact that environmental
health is an interdisciplinary field that borrows techniques from emerging and more traditional fields of study
and brings together diverse perspectives and sources of knowledge. Until environmental health matures further
as an academic discipline, it remains different things to different people. In the aggregate, however, the
academic umbrella known as environmental health includes three domains: an area of research, an arena of
applied public health practice, and a milieu for education and training. All three domains are covered to varying
degrees in this encyclopedia.
This second edition of the encyclopedia comes at the time when Environmental Health is at cross-roads.
Within the context of external factors that define its boundaries, environmental health has thus evolved over
time into a complex and multidisciplinary field that provides a framework for understanding the natural world
and dealing with how we affect it [natural world] and the affects it has on our health. On the contrary, extensive
human alteration of the natural world has resulted in remarkable improvements in most health indices
globally. The apparent contradiction stems from the fact that many of the key determinants and solutions to
environmental health lie outside the direct realm of health and are strongly dependent on environmental
changes, water and sanitation, industrial development, education, employment, trade, tourism, agriculture,
urbanization, energy, housing, culture, and national security. Environmental risks, vulnerability, and variability
manifest themselves in different ways and at different timescales and can impact human health in many
dimensions. While there are shared global and transnational problems, each community, country, or region
faces its own unique environmental health problems the solution of which depends on circumstances
surrounding the resources, customs, institutions, values, and environmental vulnerability. This important
dimension is covered severally in the group of articles on Country- and Area-Specific Environmental Health
Issues. This encyclopedia has managed to include many issues and topics especially on social determinants of
health which are not typically covered in existing environmental health textbooks and compendia and hence
has provided an expanded umbrella for the field.
A goal of the Second Edition of Encyclopedia of Environmental Health is to examine the ways for conceptu-
alizing, identifying, organizing, and addressing key environmental health problems at the local, regional, and
global scales. A number of disciplines have brought powerful concepts, methodologies, and experience to these
tasks and are constantly creating new frontiers in the field. The focus of this edition is to provide a critical
assessment of advancements in aligned research fronts that have occurred since the First Edition was published
which can be used to embellish existing theories, syntheses, and analytic structure of the growing field of
environmental health. Special emphasis has been given to recent developments in the areas of epigenetics
xxxviii Preface

(environmental inheritance), health consequences of environmental disasters (natural and human-made),

health disparities, and social determinants of environmental health, newer environmental contaminants. The
underlying view is that while environmental health must deal with threats and how to minimize them, it has
also created a wonderful framework for developing new scientific paradigms to address emerging local,
national, and global environmental concerns. Environmental challenges and our knowledge of them are
constantly evolving and this major work in the field needs to be constantly updated to reflect the current state of
research and practice.
Encyclopedia of Environmental Health is a collection of thoughtful and critical reviews written by leading experts
in the fields about which they write. The text of the articles were written at a level that allows advanced
undergraduate and postgraduate students access to the material, while providing environmental health prac-
titioners, active researchers, and public and private sector employees in related disciplines with a ready resource
for information in all aspects of environmental health. There are no unrealistic claims for answers in these
volumes, however. Confronting the determinants of environmental health is not a matter for guidebook or
blueprint; premature or undue prescriptions or programmatic approaches are likely to be misleading. Articles in
the encyclopedia seek to conceptualize the issues more clearly, to describe the best available scientific methods
that can be used in characterizing and managing environmental health risks, to extend the field of environ-
mental health through new theoretical perspectives and heightened appreciation of social, economic, and
political contexts, and to encourage a richer analysis in the field through examples of diverse experiences in
dealing with the health–environment interface. In this regard, articles in the encyclopedia have cut across several
disciplines and should be of interest to a large spectrum of readers in the biomedical, natural and social sciences.
Preparation of this encyclopedia was driven by the need to (i) provide a framework to structure the existing and
widely scattered knowledge base; (ii) place environmental health and risks in the broader context of envi-
ronmental change and associated drivers of change; (iii) identify and assess potential interventions to prevent or
remediate the risks; (iv) identify and assess major uncertainties in exposure assessment, risk characterization,
and health impact determination; and (v) provide context for defining priorities for further research.
The Encyclopedia of Environmental Health has followed the guidelines for previous encyclopedias in the Elsevier
series of major reference works. The articles have been clustered into well-defined subject sections at the
beginning of the reference work (Volume 1) for the readers’ convenience. Within the volumes, however, articles
are arranged alphabetically by title rather than thematically. Articles range in length from about 3000 to over
10,000 words, reflecting the diversity in topics covered and the level of understanding of subject material.
Authors were encouraged to use tables, diagrams, and illustrations whenever necessary. Each article contains
a “Further Reading” list designed to provide the reader with critical literature on the topic. Readers may also find
the web resources at the end of many chapters to be useful. Concerted effort was made to cross-reference the
chapters as much as possible.
The production of the first and second editions of this major reference work took many dedicated years, not
surprising for a massive enterprise that involved hundreds of authors from many disciplines and in many
countries. The foci for articles were developed by an international and multidisciplinary team of editors,
associate editors, issue editors, and consultants. Peer reviewing of the articles took more time and effort than
was expected. For a large project that involved many collaborators over a period of years, the drop out of
contributors, reviewers, and issue editors was a problem that had to be managed carefully.
This edition of Encyclopedia of Environmental Health would not have been possible without the dedicated staff
and editors at Elsevier Press and the distinguished panel of Associate Editors. Appreciation and admiration are
extended to the Associate Editors who put in incredible amounts of effort to ensure that articles in their purview
were completed to the highest quality. Ultimately, any success of this encyclopedia belongs to the outstanding
group of authors and coauthors from many disciplines and different institutions who contributed their
scholarship, knowledge, and hard work to the endeavor.

Jerome O. Nriagu
Editor-in-Chief
School of Public Health, University of Michigan
Ann Arbor, MI 48109, USA
PERMISSION ACKNOWLEDGMENTS

The following material is reproduced with kind permission of Taylor & Francis

Table 4 Residential and Non-Residential Biomass Combustion: Impacts on Air Quality

Table 6 Industrial Livestock Production Facilities Airborne Emissions
www.taylorandfrancisgroup.com

The following material is reproduced with kind permission of Oxford University press

Table 2 Carcinogenicity of Disinfection Byproducts in Humans: Epidemiological Studies

Figure 4 Human exposure to cyclic volatile methylsiloxanes
Figure 3 Impact of Natural Dusts on Human Health
Figure 1 1976 Trichlorophenol Reactor Explosion at Seveso, Italy
Table 4 1976 Trichlorophenol Reactor Explosion at Seveso, Italy
Figure 1 Human Health Link to Invasive Species
Figure 2 Polymorphism and Gene-Environment Interactions in Environmental Cancer
Text The Impact of Environmental and Anthropogenic Factors on the Transmission Dynamics of Vector Borne
Diseases
www.oup.com

The following material is reproduced with kind permission of American Association for the Advancement of
Science

Figure 1 Impact of Natural Dusts on Human Health

Figure 1 Volcanoes and Human Health
Text The Impact of Environmental and Anthropogenic Factors on the Transmission Dynamics of Vector Borne
Diseases
www.aaas.org

The following material is reproduced with kind permission of Nature Publishing Group

Figure 2 Exposure Modeling and Measurement: Exposure Factors

Figure 4 Occurrence of particles in indoor air (PM and PNC)
Text The Impact of Environmental and Anthropogenic Factors on the Transmission Dynamics of Vector Borne
Diseases
http://www.nature.com

i
This page intentionally left blank
 Advances in Analytical Methods for the Determination of Pharmaceutical
Residues in Waters and Wastewatersq
Despo Fatta-Kassinos, University of Cyprus, Nicosia, Cyprus
Anastasia Nikolaou, University of the Aegean, Mytilene, Greece
Lida Ioannou-Ttofa, University of Cyprus, Nicosia, Cyprus
© 2019 Elsevier B.V. All rights reserved.

Abbreviations
dSPE Dispersive solid-phase extraction
GAC Green analytical chemistry
HPLC High-performance liquid chromatography
LPME Liquid-phase microextraction
MEPS Microextration by packed sorbent
MMLLE Microporous membrane liquid–liquid extraction
mSPE Magnetic solid-phase extraction
Q-TOF Quadrupole ion trap-time-of-flight
QuEChERS Quick, Easy, Cheap, Effective, Rugged and Safe
SBSE Stir-bar sorptive extraction
SLE Supported liquid extraction
SPE Solid-phase extraction
SPME Solid-phase microextraction
UPLC Ultra performance liquid chromatography

Introduction

A large number of different chemical classes of pharmaceuticals are consumed by humans, husbandry and aquaculture. Most of the
pharmaceutical compounds are complex molecules with different functionalities and physicochemical and biological properties.
Two important characteristics of these compounds are their ionic nature and inherent biological activity. Their molecular weights
range typically from 300 to 1000, and they can either have basic or acidic functionalities. Pharmaceuticals can be classified into
different categories based on their chemical structure and mode of action on the target organs. The main categories of pharmaceu-
ticals and their mode of action are given in Table 1.
After their consumption, pharmaceuticals are metabolized in the organism and then they are excreted in either their parent form
or as metabolites. Bio-degradation modifies the chemical structure of the active molecules, which in turn often results in a change in
their physicochemical and pharmaceutical properties.
Metabolism may lower pharmaceuticals’ activity or enhance their water solubility to facilitate the excretion from the body. In
most cases, however, metabolism is incomplete. There are two important pathways of metabolism. Phase I metabolites result
from the modification of the active compound itself by hydrolysis, oxidation, reduction, alkylation, and dealkylation. Phase II
metabolites are phase I metabolites that have been modified by glucuronation or sulfatation to enhance excretion. Therefore,
administered parent compound may be excreted (i) unchanged, (ii) as a glucuronide or sulfate conjugate, (iii) as a major metab-
olite, or (iv) as a complex mixture of many metabolites. It is also important to note that under environmental conditions pharma-
ceutical molecules can be neutral, cationic, anionic, or zwitterionic. As comparatively large and chemically complex molecules, the
heteroatom content and multifunctional composition of pharmaceuticals make them polar and ionizable molecules. These prop-
erties are largely dependent on the pH of the solution.
The metabolites of pharmaceuticals can be subjected to further transformation in the sewage treatment plants or in surface water
and/or groundwater since biotic or abiotic processes, such as hydrolysis and photolysis may also degrade pharmaceutical
substances. The transformation products (TPs) are of major concern, because they are often more persistent and exhibit similar
to or even higher toxicity than the parent compounds.
As Fig. 1 illustrates, pharmaceuticals and their metabolites can enter the environmental aqueous and soil matrices mainly
through excretion and disposal via wastewater. Owing to the incomplete elimination in wastewater treatment plant (WWTP),

q
Change History: April 2018. Lida Ioannou-Ttofa prepared the update. Affiliations, Keywords, and Figure 3 have been updated.
This is an update of D. Fatta-Kassinos, S. Meric and A. Nikolaou, Advances in Analytical Methods for the Determination of Pharmaceutical Residues in Waters
and Wastewaters, In Encyclopedia of Environmental Health, edited by J.O. Nriagu, Elsevier, 2011, Pages 9–16.

Encyclopedia of Environmental Health, 2nd edition, Volume 1 https://doi.org/10.1016/B978-0-12-409548-9.11247-3 1

2 Advances in Analytical Methods for the Determination of Pharmaceutical Residues in Waters and Wastewaters

Table 1 Main categories of pharmaceuticals and mode of action

Category Mode of action

Analgesics Relieve pain

Antacids Relieve heartburn and indigestion by neutralizing the stomach acid
Antianxiety drugs Suppress anxiety and relax muscles; other names anxiolytics, sedatives, or minor tranquilizers
Antiarrhythmics Control heartbeat irregularities
Antibacterials Treat infections
Antibiotics Combat bacterial infection
Anticoagulants and Prevent blood from clotting and help to dissolve and disperse blood clots and may be prescribed for patients
thrombolytics with recent arterial or venous thrombosis
Anticonvulsants Prevent epileptic seizures
Antidepressants Mood-lifting agents
Antidiabetic Stabilize and control blood glucose levels among people with diabetes
Antidiarrheals Relief of diarrhea
Antiemetics Prevent nausea and vomiting
Antifungals Treat fungal infections
Antihistamines Counteract the effects of histamine, one of the chemicals involved in allergic reactions
Antihypertensives Lower blood pressure; include diuretics, b-blockers, calcium channel blocker, centrally acting antihypertensives,
and sympatholytics
Antiinflammatories Reduce inflammationdthe redness, heat, swelling, and increased blood flow found in infections and in many
chronic noninfective diseases, such as rheumatoid arthritis and gout
Antineoplastics Treat cancer
Antipsychotics Treat symptoms of severe psychiatric disorders (also called major tranquilizers)
Antipyretics Reduce fever
Antivirals Treat viral infections or they are used to provide temporary protection against infections, such as influenza
Beta-blockers Reduce the oxygen needs of the heart by reducing heartbeat rate
Bronchodilators Open up the bronchial tubes within the lungs when the tubes have become narrowed by muscle spasm, such as asthma
Cold cures Prevent the aches, pains and fever that accompany a cold can be relieved by aspirin or acetaminophen
Corticosteroids Antiinflammatories in arthritis or asthma or as immunosuppressives, acting also for preventing some malignancies or
compensating for a deficiency of natural hormones
Cough suppressants (1) Alter the consistency or production of phlegm, such as mucolytics and expectorants; (2) Suppress the coughing reflex,
such as codeine (narcotic cough suppressants), antihistamines, dextromethorphan and isoproterenol (nonnarcotic
cough suppressants)
Cytotoxics/cytostatics Kill or damage cells as antineoplastics (used to treat cancer) and also as immunosuppressives
Decongestants Reduce swelling of the mucous membranes that line the nose by constricting blood vessels, relieving thus nasal stuffiness
Diuretics Increase the quantity of urine produced by the kidneys and passed out of the body, ridding the body of excess fluid; reduce
water logging of the tissues caused by fluid retention in disorders of the heart, kidneys, and liver; useful in treating mild
cases of high blood pressure
Hormones Hormone replacement
Immunosuppressives Prevent or reduce the body’s normal reaction to invasion by disease or by foreign tissues. Immunosuppressives are used
to treat autoimmune diseases and to help prevent rejection of organ transplants
Lipid regulators Reduced the levels of fats (lipids), such as cholesterol, in the blood, called hyperlipidemia
Sex hormones (female) Estrogens and progesterone, responsible for development of female secondary sexual characteristics, to treat menstrual
and menopausal disorders and are also used as oral contraceptives. Estrogens may be used to treat cancer of the breast
or prostate, progestins (synthetic progesterone to treat endometriosis)
Sex hormones (male) Androgenic hormones are responsible for development of male secondary sexual characteristics. They may be used to
treat breast cancer in women, but either synthetic derivatives called anabolic steroids, which have less marked side
effects, or specific antiestrogens are often preferred. Anabolic steroids also have a “body building” effect that has led to
use in competitive sports, for both men and women
Sleeping drugs Induce sleep are benzodiazepines and barbiturates. Benzodiazepines drugs are used more widely than barbiturates
because they are safer, the side effects are less marked, and there is less risk of eventual physical dependence
Tranquilizers Keep calm or sedative effect. Minor tranquilizers should be called antianxiety drugs, and the drugs that are sometimes
called major tranquilizers should be called antipsychotics

Source: FDA/Center of Drug Evaluation and Research (2009).

pharmaceutical residues are found in surface waters, soils irrigated with treated wastewater, and groundwater replenished with
treated wastewater or aquifers that communicate with surface water already loaded with such compounds. Therefore, it is apparent
that municipal, as well as hospital wastewater effluents are the most important sources of human pharmaceutical compounds, with
contribution from wastewater effluents from pharmaceutical manufacturing companies and landfill leachates, as well as disposal of
unused medicines into the environment. Additionally, veterinary pharmaceuticals enter the environment after the application in
animals in farms and the subsequent runoff of the manure, as well as after direct application in aquaculture. Pharmaceuticals,
present in the environment at microgram per liter to nanogram per liter levels are of particular concern because of both their
 Advances in Analytical Methods for the Determination of Pharmaceutical Residues in Waters and Wastewaters 3

Fig. 1 Sources and fluxes of pharmaceutical residues into the environment. Adapted from Nikolaou, A., Meric, S., and Fatta, D. (2007). Occurrence
patterns of pharmaceuticals in environmental matrices. Analytical and Bioanalytical Chemistry 387, 1225–1234.

ubiquity in the aquatic environment and health effects. Pharmaceutical residues have been detected in many environmental
matrices worldwide including water, wastewater, sediments and sludge. The characteristic of a pharmaceutical compound, which
determine whether this will enter the aquatic environment or remain adsorbed on solid particles is hydrophilicity, that is given
by the biosolids/water distribution coefficient, in other words Kbiomass or Kp.
Some of the most frequently detected pharmaceutical compounds in water and wastewater can be seen in Fig. 2.
The abundance of antibiotic compounds potentially due to their overuse, misuse and incomplete removal by conventional
WWTPs, accompanied by the presence of antibiotic-resistant bacteria (ARB) and their associated antibiotic resistance genes
(ARGs) has been witnessed in the last decades in treated wastewater effluents. It is widely accepted that the conventional biological
processes (i.e., conventional activated sludge) currently applied in WWTPs create an environment potentially conducive to

Analgesics/Anti-inflammatory:
Beta-blockers:
Diclofenac, ibuprofen, paracetamol,
naproxen, ketoproxen Propranolol, atenolol, metoprolol

Steroids:
Antiepileptic:
17-β estradiol, estrone, estriol,
Carbamazepine
17-a ethinylestradiol

Antibiotics: Lipid regulators:

Ofloxacin, sulfamethoxazole, Gemofibrozil, fenofibrate,
erythromycin, trimethoprim bezafibrate, clofibric acid

Fig. 2 Most frequently detected pharmaceuticals in aqueous matrices.

4 Advances in Analytical Methods for the Determination of Pharmaceutical Residues in Waters and Wastewaters

antibiotic resistance development, since environmental- and commensal-derived bacterial communities are in close contact, facil-
itating thus the generation and proliferation of new resistant strains via horizontal gene transfer. Thus, is it of high importance to
improve the tertiary treatment processes applied in WWTPs for disinfection (i.e., chlorination, UV oxidation, ozonation). However,
little knowledge is still available regarding the operating parameters that may influence the removal mechanisms of ARB&ARGs
during the application of the above processes.

Current Status With Respect to Sampling, Sample Preparation and Extraction Methods

The quantification of pharmaceuticals in human biological matrices, such as urine and blood is feasible since a long time. The quan-
tification, however, in environmental matrices has become feasible due to the very low concentrations in which these compounds
exist and most importantly due to the fact that these matrices are very complex matrices containing a big number of different organic
molecules. The presence of pharmaceuticals in WWTP effluents, surface, drinking and groundwater has become an issue of great
interest, although it is probable that these compounds have been entering surface and groundwater systems for as long as people
have been using them. The challenge therefore of modern environmental analytical chemistry is a continuous effort to search for
a continuously increasing number of “new” contaminants including pharmaceutical residues at trace levels. Some years ago analyt-
ical techniques and equipment capable of measuring milligram per liter in water samples were considered as state of the art.
Currently, a number of analytical techniques are available that are capable of measuring concentrations down to the parts-per-tril-
lion levels. In parallel to the remarkable developments of increasing chromatographic resolution, detection sensitivity and speci-
ficity has been the ability to extract and enrich compounds of interest from extremely complex matrices, such as wastewater,
soil, sediment, and sludge.
Fig. 3 demonstrates the sample preparation procedures and the most common analytical methods used for the analysis of phar-
maceutical compounds in aqueous matrices. The analytical processes for complex aqueous samples contain several steps, which can
significantly affect the accuracy of the final result, such as sampling, sample pretreatment, extraction, identification and data pro-
cessing, as shown in Fig. 3.
During sampling, the representative sampling point and the appropriate sampling method (i.e., continuous mode (e.g.,
flow-proportional and constant samples) or discrete mode (e.g., time-proportional, flow-proportional, volume-proportional
and grab samples)) should be carefully chosen. The times and frequencies of sampling can be properly decided after detailed
preliminary work. Since, it is well known that the rainfall events influence the contaminants’ concentration in surface water and
WWTP effluents, it is recommended samples to be taken during dry weather conditions. Finally, the storage, preservation and
transport of the aqueous sample from the point of collection to the analytical laboratory must occur without any changes in
sample’s physicochemical properties. For complex aqueous matrices, a sample pretreatment step is necessary, to provide

LLE
SPE
LPME
filtration SPME
pH adjustment Extraction SBSE
etc QuEChERS
MEPS
etc

Sample pretreatment
Clean up LC-MS
Sample transport Identification LC-MS/MS
UPLC-MS/MS
Q-TOF-MS
GC-MS
GC-MS/MS
LCxLC
GCxGC
NMR
etc
Sampling collection

Data
processing
Fig. 3 Common workflow diagram during pharmaceutical pretreatment, analysis and quantification.
Another random document with
no related content on Scribd:
 For seeing herself made of so little account before the eyes of all,
Elissa, disgusted and disgraced, determined to put an end to her
miserable existence once and for all.
But Cleandra, as upon a previous occasion, urged her yet to live
for her country’s cause. And this was upon the very night on which
Cleandra obtained from Æmilius Scipio’s letter, which came as balm
to soothe her. It was written in Greek, and was as follows:—

“From Publius Cornelius, son of Publius Cornelius Scipio, to

Elissa, daughter of Hannibal.

“In the name of the great god Jupiter, lord of the universe,
greeting! The years have passed away one by one with
rapidity, and great and sudden have been the changes upon
the face of the world. But one thing hath neither passed away
with time nor altered with change. As Scipio did love thee
when thou didst even weep upon his shoulder upon bidding
him farewell in New Carthage, so doth he now love thee upon
sending thee these lines of greeting from Rome. And greatly
doth he long to have tidings of thee by thine own hand, and
still more to again behold thy beautiful and beloved features.
“Elissa, I, Scipio, have been fighting all these years in
Iberia, and have driven out thine uncle Hasdrubal in the north,
who marched across the Alps into Italy, and fell bravely
fighting at the battle of the Metaurus. I have likewise driven
out thine uncle Mago in the south, who, after retiring for a
space to the Balearic Islands, hath now seized upon the city
and province of Genoa in Northern Italy. Hasdrubal, the son of
Gisco, have I also met in various bloody encounters, in which
the gods were ever propitious to me and to the arms of Rome.
Thus all Iberia hath fallen into my hands, and I am now
recalled to Rome. For owing to the continued presence of thy
father and his armies, after so many years, even yet
continuing the struggle with occasional successes in the south
of Italy, and on account of the great insult that he put upon the
city of Rome herself, in riding up to her walls and throwing his
javeline over the very city gates, the Romans are now
determined to take by my hand means to avenge these insults
by carrying the war beyond our coasts upon African soil. And
since there is no secret made of this determination, I do write
unto thee upon the subject for thine own welfare. For, my
beloved, even as I have loved thee, and offered up my
prayers and sacrifices unto the gods for thy sake during all
these my vicissitudes by war, so do I still consider thee and
love thee with a single-minded devotion that nought save
death may change.
“Therefore, no thought of any possible military glory which
may accrue unto myself can weigh in the balance where thy
happiness and welfare are concerned, especially since I see
that through thee any further bloodshed may now be avoided.
For thy country of Carthage may be even yet saved from
invasion if thou wilt but hearken unto my words and come to
me now, when I will espouse thee, and peace will be made
between Rome and Hannibal. For both sides are utterly weary
of this endless war, and thy father Hannibal, after having lost
Capua, which was retaken by our arms despite his repeated
attempts to relieve it, after having lost Tarentum, which is also
retaken by Rome, after having lost nearly all his Numidian
cavalry at the town of Salapia, including, it is said, thine old
lover Maharbal, is now reduced to the position of a wolf
guarding the mountain passes of Bruttium and the few Greek
cities on the Bruttian promontory beyond. ’Tis true that, like
the bold wolf that he is, he doth occasionally sally forth from
his corner of Italy, and ever with certain success; and hath
even recently, in one of these expeditions, slain the mighty
Marcus Marcellus himself, the sword of Rome, the conqueror
of Syracuse, for whose memory thou canst bear no great
love. For I did hear how, after thine escape with Cleandra, by
the treachery of the flag-captain, from Caius Lælius’s ship—
which escape did greatly chagrin both Caius, on account of
Cleandra, and myself—fearing for thy life in Syracuse—thou
didst bravely fight against Marcellus throughout the whole
siege, ay, even until the fall of the city. And since then,
although having learned with greatest joy of thine escape from
death in the final massacre of Syracuse, I have become
aware, with deep regret, of thy residence at the court of Philip
of Macedon. From him I would have thee at once fly in the
ship with Marcus Æmilius, the bearer of this letter, whom thou
didst meet with me in Numidia. For it is not possible but that
the doings of the daughter of Hannibal must be known
everywhere, especially when that daughter is Elissa, whose
beauty and feats are so celebrated. Hence I, in common with
all the Romans, have perfectly understood that it is thou
thyself Elissa who hast been the cause of the war between
Philip of Macedon and Rome. For knowing thy devotion to thy
country, it is not difficult for me to clearly understand with what
object thou hast consented to live with the base Macedonian
wretch, whom, so I have recently heard by spies, maketh thee
by no means happy. But for one reason do I ardently desire
the continuation of that war of thy making with Philip, and that
is that the gods may spare me to drive my sword up to the hilt
in the throat of the scoundrel king. For hath not he, by nought
save guile and wickedness, gained possession of that one
dear flower of womanhood which I would have plucked and
worn myself; and hath not he again, after having himself
ravished the flower from its stem, now left its petals in all their
sweetness to wither and perish with neglect? Therefore,
accursed be he—ay, doubly accursed—by all the gods!
“Now Elissa, my beloved, after deep communing with the
mighty Olympian gods, who have even appeared unto me in
dreams, they have clearly pointed out to me both my duty to
my country and to the woman whom I love, and also the duty
to her country, to herself, and even to me, Scipio, of that
woman, she being Elissa, the daughter of the great Hannibal,
son of Hamilcar Barca. Thus the gods themselves, by whom,
as thou knewest in times past, I am beloved, and who appear
unto me still, even as did Neptune, god of the sea, before the
fall of the New Town, have clearly directed thy course for thee
for the sake of thine own country’s welfare. Since, moreover,
there is now no longer the shadow of the Numidian Maharbal
between us, do I beseech thee to fly from the court of this
dissolute Philip, and come to Rome with Marcus Æmilius; and
then I pledge thee my troth that, saying never a word of
reproach concerning the said Philip, I will make thee my loved
and honoured wife. And there shall thus, by thee, be peace
again between Carthage and Rome, after so many years of
warfare and of misery. Now, farewell, Elissa. I prithee salute
the lady Cleandra if she be still with thee; Caius Lælius
likewise sendeth her salutations. As for thyself, I commend
thee to the blessing of the gods.
“(Sealed) Scipio.”
 CHAPTER V.
A SCENE OF HORROR.

It was night, a calm summer night, when Elissa, after reading

Scipio’s letter, remained alone within a gorgeous pavilion in a camp
established upon the shores of the Hellespont, the letter lying
listlessly upon her lap. With head thrown back upon the cushions of
her divan, the light of a single cresset lamp, formed of gold in a
chaste design, but barely illumined her features, for she was
withdrawn, while thus leaning back, from the radius of its not too
powerful glow. The doors of the tent being open, Elissa could see the
radiant moonbeams without dancing upon the waters of the
Hellespont, and lighting up at the same time the tideless sea and the
mountains upon the further shore.
The Carthaginian maiden rose, and stepping without the tent
gazed wistfully across the straits. How peaceful would have been the
scene had Mother Nature alone been the all-pervading genius of the
surroundings.
But, alas! there were other and more horrid sights and sounds,
making the night, otherwise so beautiful, most terrible in all its
aspects.
On every side could be seen flaming houses; in all directions could
be seen the flying forms of screaming women and children, as their
fathers, husbands, or lovers, carrying out the fearful compact made
among themselves, ruthlessly pursued those nearest and dearest to
them to put them to a cruel death.
At hand here and there could be seen, even close to the tents of
the royal encampment, shapeless, huddled-up forms lying on the
ground. Some of these, lighted up by the rays of the brilliant moon,
or glittering in the flickering light of the fires, betokened that they
were the bodies of dead warriors; others, from their white,
disordered, and oft-times blood-stained raiment, were clearly the
corpses of some of the unhappy female victims. Some, indeed, of
the prostrate women, as appeared by their writhings and spasmodic
struggles, were not even yet dead, but no one took the trouble to put
them out of their misery, for the groups of Macedonian guards who
were here and there lying about the open space, were evidently all
under the influence of numerous libations, and were in a drunken
sleep, utterly careless of their surroundings. Meanwhile, while the
fires around ever crackled and roared, and the heavy smoke drifted
away landward before a faint sea breeze, louder and more
discordant sounds disturbed the midnight air.
From an adjacent and brilliantly lighted pavilion there arose, all
combined, noisy shouts, uproarious laughter, and the screams of
women.
Walking unmolested across the open space which separated her
pavilion from that of the king, and carefully avoiding stepping upon
any of the corpses as she went, Elissa looked within. The sight that
she saw filled her with loathing and disgust. For Philip and his
courtiers, lolling round a huge table, covered with gold and silver
wine-cups, were making merry of the misery of many beautiful young
women, their recent captives, whose tear-stained faces and
disordered dress told only too plainly the brutality to which they were
exposed.
The king himself was a ring-leader at the horrid game which they
were playing with the struggling young women. Holding forcibly a
damsel upon each knee, he was, with hilarious laughter, delighting at
their unavailing struggles, while some of his sycophants poured by
force between their unwilling lips, cup after cup of the rich red wine.
Thus were they making drunk, in spite of themselves, the miserable
maidens, many of whom had probably never even tasted wine
before. Some of the young girls had already thus been reduced to a
state of intoxication, and were reeling about the spacious apartment,
or lying helplessly, grotesquely weeping, on the floor. The onlooking
Macedonian nobles meanwhile shouted with laughter. It was a
terrible sight! Not only did it fill her with terror at what might
perchance befall herself, but the horror and anger that filled Elissa’s
mind drove her to an awful resolve. Seizing a firebrand from a
deserted watch-fire, she advanced once more stealthily towards the
windward side of the huge tent, intending to burn alive this satyr of a
king and all his horrid crew. But, just in time, she remembered that
she would have to burn as well all the wretched young women.
Therefore, although she rightly considered that a speedy death
would be far better for them than a life under such conditions, she
could not find it in her heart to let the poor helpless victims die so
painfully. With a groan she threw the firebrand back into the fire, and,
invoking all the curses of the gods upon the head of Philip, she
retired once more to her tent. Here, trying to shut her ears to the
roaring of the fires, the screaming of the dying women and children,
the brutal shoutings of the drunken nobles, and the miserable
lamentations of the insulted maidens, she once more read through
Scipio’s letter.
She made up her mind at once that Scipio was right, that her duty
to her country was, whatever it might have been in the past, now
undoubtedly to proceed to Rome, and, by espousing Scipio, whose
devotion touched her heart deeply, to conclude a peace, if possible,
between Rome and Carthage. Two reasons strongly impelled her.
One was that the death of her once so deeply-beloved Maharbal had
now removed a great barrier; the other, that she believed firmly, with
many others, that Scipio was indeed, as he pretended, a man
specially favoured by the gods, and that they held personal
communings with him, and to her mind these divine inspirations
accounted for all his successes. Of one thing, at all events, Elissa
was certain, that she wished for no more war. For, if her efforts to
embroil Philip in the struggle between Carthage and Rome had only
resulted in such terrible scenes as she had been witnessing during
the last few days, she felt convinced that such war must be
distasteful to the gods themselves. Therefore she determined to use
all her endeavours now to bring about a lasting peace, for that was,
since the gods themselves had declared it, clearly at this juncture
her duty to her country, and to the world at large.
Elissa summoned Cleandra, who was even more terrified than
herself at the awful scenes around, and with reason, for upon
returning from the tent of Marcus Æmilius only an hour previously,
she had had a very narrow escape of her life from some of the
citizens of Abydos. They had been upon the point of slaying her by
mistake for one of their own women, when fortunately some
Macedonians of the royal guard, to whom she was known, had come
to her assistance, and had slain her aggressors. But now the guards
were all drunk, and the two women knew that if they were to escape
they must reach alone the camp of the Roman embassy, which,
being on the shore close to the Roman ships, was carefully
entrenched and properly guarded by the ambassador’s own escort.
Cleandra, who had, when in the tent of Æmilius, had her wits
about her as usual, had not been wasting her time. She knew all
about the drift of the contents of Scipio’s letter, and had even heard
of the death of Maharbal before Elissa gave her the tidings, but she
had preferred to keep her own counsel until her mistress and friend
should learn them for herself from the letter.
Not waiting for Elissa to make up her mind to fly, Cleandra had laid
her schemes, anticipating Elissa’s consent. She had accordingly
arranged with Marcus Æmilius to have all his men ready on board
ship, and everything prepared for instant sailing, promising him to
return with Hannibal’s daughter, if possible, before dawn.
In the event of her not being able to prevail upon Elissa to fly,
Cleandra had begged the gallant young Roman to leave Abydos
without her, for she was resolved herself to share Elissa’s fortunes
for weal or woe in the future as in the past. Nor could the prayers of
Marcus, who was most loath to leave her, that she should herself fly
with him, move Cleandra in the least; for, although ever fickle with
men, she was faithful beyond the fidelity of women where Hannibal’s
daughter was concerned.
Scarcely staying to console Elissa upon the death of Maharbal,
which she evidently felt deeply, Cleandra set about collecting all their
jewellery and money, and concealing it about her person. As for
Elissa, she donned instantly her war-gear, and armed herself with a
sheath, darts, and a sword, for in this garb she had no fear of not
being able to pass in safety through any such parties of the
Macedonian guards as might not be too intoxicated to recognise her.
Bidding Cleandra cover herself with a dark cloak and to follow her,
she, after extinguishing the light, stepped forth from her tent, the
entrance to which she closed. Then passing in rear of the king’s
pavilion, where the noise was not now quite so excessive, they took
their way to the Roman entrenchments.
 They had passed the royal tent in safety, and, while threading their
way with caution, were nearly out of ear-shot of the royal
encampment, when suddenly they came, standing outside their own
tents, upon two of the most debauched nobles of a debauched court,
Alexander, son of Phidias, and Xenacreon, son of Themistocles.
Xenacreon had for long ardently pursued Cleandra, and, despite her
cloak, he recognised her in a moment. Bounding forward he seized
her, exclaiming:
“Aha, my lady Cleandra! whither away thus in disguise like a thief
in the night? For sure thou seekest a lover; well, here am I all ready
to thy hand, take me!” and he embraced her rudely.
Cleandra did not seek to struggle at first, but only to temporise.
She answered civilly, for she did not wish the sound of the
discussion to reach the king in his tent.
“I pray thee release me, my good Xenacreon, and I will meet thee
some other time. Just now I may not stay; I am engaged on
important business with the lady Elissa.”
“With Elissa, the king’s courtesan, now out of favour!” exclaimed
Xenacreon loudly. “Well, what is good for one is good for another. I
will not, so that I get thee, grudge her to Alexander here, who long
hath admired her; so take her, Alexander, I give her unto thee! But
come thou with me now, sweet Cleandra, no time is like the present.”
And while he sought to drag her within his tent, Alexander sprang
forward swiftly and attempted likewise to seize upon Elissa herself.
But she was far too quick for him, and leapt nimbly on one side,
discharging, as she did so, a dart which transfixed him through and
through. He fell groaning to the ground, writhing in agony.
“Now for thy turn, Xenacreon!” cried Elissa. “Take thou this for thy
dastardly insult to ‘the king’s courtesan, now out of favour.’ ”
And she plunged her sword deep into his body below the upraised
arms with which he held Cleandra. Snatching Cleandra from his
grasp before there was time even for her to be stained with his
blood, Elissa started running, dragging Cleandra after her, for she
perceived that the king himself had rushed out of his tent, followed
by such of his officers as could stand.
But, although raising hoarse, drunken cries, they ran in the
direction of the women, they could not see them, or, indeed, their
own way, for on coming out into the darkness from the brilliant light
they were blinded, and caught their feet in the numerous tent ropes,
and fell sprawling in all directions. Some of them even got so far as
the prostrate bodies of Alexander and Xenacreon, over whose still
breathing forms they fell heavily, while cursing loudly. But Cleandra
and Elissa easily escaped, and soon reached the Roman
entrenchments in safety, where Marcus Æmilius was waiting in
person to receive them.
Welcoming them heartily, he quickly took them off to his ship. Then
withdrawing his guard, but leaving his camp standing so as to
deceive the Macedonians in the early morning, he set sail at once
with his three vessels, and soon they felt the cool breezes of the
Ægean Sea blowing in their faces. Long before dawn they were well
out of sight of land, and steering a course for Tarentum on the
Iapygian promontory.

END OF PART V.
 PART VI.

CHAPTER I.
A SPELL OF PEACE.

For the first time for years Elissa was able to enjoy a space of
peace of mind and body. Lying back upon her cushions, beneath the
awnings on the deck of the stately ambassadorial quinquereme, she
was at length at rest. Lulled rather than disturbed by the swishing
sound of the five banks of oars moving in absolute unison, she
gazed out languidly at the successive red-cliffed and grass-clad
islands of Greece and felt happy. For now all suspense was over,
she had resolved upon her future course; and, as Polybius has said,
there is naught so terrible as suspense. Let the circumstances of life
be good or bad, while they are hanging in the balance there is ever
anxiety, agitation, impatience, to distress the mind. But once they be
decided one way or another the soul is relieved; if decided for evil,
then the worst is known already, if for good, the heart will cease from
painfully throbbing in anxious agitation, and be at rest.
Thus, then, was it with Elissa, as, for want of wind, propelled
merely by the oars, the ship glided steadily onward over the sunny
summer seas. Now she had no longer any anxiety as to the port for
which her life’s bark was steering. She had made up her mind at
length to marry Scipio, and was clearly satisfied that her ship of life
was having its course shaped by the great gods who ruled her
destiny, and that therefore that course must be right, and her own
determination a righteous one.
So, even while thinking of Maharbal with a softened regret—for he
was scarcely more to her than a dream of years long gone by—she
allowed herself the almost unknown luxury of being happy. And the
happiness came, not from any sense of satisfaction at a realised
ambition, nor from the feeling of joy that is experienced in the
attainment of a long-desired love, but simply from the relief obtained
after long battlings in stormy waters. Now the guest and not the
prisoner of Rome, she day after day enjoyed her calm repose, and,
while fervently thanking the gods for her relief from the degrading
atmosphere of Philip’s court, did not weary her mind with anxious
forebodings or misgivings for the future. She thought, it is true, of
Scipio, and thought of him frequently, but it was more in admiration
of his nobility of soul than with the ardent passion of a lover.
That passion, indeed, he had inspired years ago, but it had been
in spite of herself, and she had known how to do her duty to her
absent lover in repressing it. Now she felt that she loved him indeed,
and deeply, but the affection which she felt in her inmost
womanhood was, she was aware, more like that very love of a sister
which she had formerly professed for him, than that more thrilling
love of mutual passion which she knew they had both experienced in
bygone days.
The moderated nature of her sensations, however, did not trouble
her; on the contrary, their very moderation was a part of the relief of
mind which she now experienced. She loved Scipio in a pure way,
and she longed to see him and to tell him her deep and great
admiration for the grandeur of his soul; the other feeling might come
back again later, on meeting again. If so, she would welcome its
return gladly, for she felt that Scipio deserved something more at her
hands than mere sisterly love; but in the meantime it suited her
wearied brain to think about him, as of all other things, tranquilly. For
her past had in very sooth been stormy enough under all its aspects,
from its very commencement as a child with her father in scenes of
war; as a maiden, in her mad and unreasoning passion for Maharbal
and the grief of separation from him; then later during the bloody and
terrible sieges of New Carthage and Syracuse; and last, but by no
means least, the terrible humiliation endured in the court of the
Macedonian king.
Elissa was now no longer a girl, and, as she closed her eyes and
thought dreamily of all her past, she realised that for nothing on earth
would she live over again the terrible years that had rolled over her
head since she had changed from an inexperienced maiden to an
experienced woman, whose life was far too highly filled with incident
for anything approaching to real happiness to find a home within her
breast. But she was happy now at length for a season, after all her
warrings and wanderings, and, realising this fact, she wished that the
peaceful voyage might never come to an end.
Cleandra, in the meantime, was adapting herself to circumstances
as usual, and was happy too. For, forgetting her first husband, Imlico
the Carthaginian noble, whom she had taken as a mere means to an
end—to escape from slavery to wit; forgetting also her second
husband, the Roman flag-captain Ascanius, whom she had taken for
a similar reason, she had now for the first time in her life fallen
deeply and ardently in love. And this time her love was, she well
knew, as ardently and truly returned by Marcus Æmilius, the
youngest of the Roman ambassadors, whom King Philip had rightly
designated as the handsomest man of his time.
Thus Cleandra looked forward to the time when Elissa should be
united to Scipio with pleasant anticipations of herself, upon the same
occasion, becoming once more a bride, and this time a bride entirely
from choice, not from necessity. Meanwhile, as there was a band of
musicians on board the young ambassador’s ship, consisting of
minstrels and dancing girls, the evenings passed merrily with song
and dance. Thus the time sped gaily enough.
The ships, after passing through the Grecian islands, hit off the
southernmost coast of the Peloponnesus but did not touch
anywhere. But once the western side of the lowermost parts of
Greece had been gained, a strong western breeze set in, on account
of which the land was not only closely hugged, but frequent
stoppages were made at various ports or inlets. For the inhabitants
of the western coast were, if not exactly friendly to Rome, afraid of
Rome, and, above all, the name of Philip was abhorred in those
parts. Therefore, frequent landings were made in convenient creeks
and inlets, and, to pass the time, when the wind was too strong
without, the seine nets would be got out, and a morning or afternoon
employed innocently in fishing beneath the shadow of a headland in
some land-locked bay.
 It was delightful to Elissa now, her armour all laid aside, clad in
modest raiment given to her by the minstrel girls on board, to join in
these fishing parties. She loved also to watch the sea-gulls grouped
on the rocks, or the nimble-winged flying-fishes springing like a
covey of partridges from the foam. What, in her present softened
mood, when all relating to war and death was distasteful, grieved
her, however, was that even to capture the innocent fishes meant
death to some of the creatures created by the gods, while she soon
learned that when the flying-fishes sprang into the air, it was only
because a group of porpoises was pursuing them. Moreover, she
observed that, especially when near the coast, the ospreys or fish-
eagles, swooping down from their eyries, would often seize them in
their talons. Thus, if they escaped by taking flight from one danger in
the sea, they, nevertheless, succumbed to another danger in the air.
And whenever Elissa allowed herself to think at all, a thing that she,
with all her will, did her utmost to avoid, she vaguely hoped that her
fate might not be that of a flying-fish springing from one danger, that
it knew of close at hand in the water, to another, that it knew not of,
in the air.
But she realised, from thus observing the birds and the fishes,
that, even in the calmest scenes of nature, the eternal laws of death
and destruction are ever present and in force; that there is nought
that liveth but must die, and die, more frequently than not, by a cruel
death. All this only strengthened all the more her serious resolve to
do all within her power to save unhappy humanity from further
suffering, and for the future to work in the interests of peace alone.
Having made up her mind firmly on this point, she determined
further that never again would she raise her own hand in warfare,
that never would she wear armour more.
Calling Cleandra, she bade her bring to her, where she was
reclining under a silken canopy on the poop, the light cuirass and
helmet incrusted with gold that had protected her in many a fight, the
trusty sword with which she had struck in the wars with Mago, in the
defence of the New Town and in the streets of Syracuse, many a
blow on behalf of Carthage. She bade Cleandra bring also to her the
sheath of darts, whence she had drawn years before the weapon
which had slain Cnœus Scipio, and quite recently that which had
procured her escape from Alexander, son of Phidias, by causing his
death.
Lastly, she bade Cleandra bring her beautiful shield of polished
steel, inlaid with gold, bearing on its centre a golden representation
of the horse of Carthage. When Cleandra had placed all these
weapons and arms by Elissa’s side on the deck, she asked, with
some curiosity:
“What wilt thou do with thine armour to-day, Elissa? Here in this
land-locked bay there is nought for thee to fight, unless it be with
yonder monstrous shark, whose triangular back fin appeareth
moving lazily above the surface of the pellucid waters. Ugh! I hate
sharks! and this one hath followed us for days. Canst thou not fancy
his horrid teeth meeting through thy flesh?”
And, clasping her hands to her bosom, Cleandra shuddered.
“Ay, what would the lady Elissa do with her arms here upon my
ship?” asked courteously Marcus Æmilius, who had followed
Cleandra. “Hath she cause of offence against any person that she
need defend herself while being my guest? If so, by the Olympian
Jove, the offender shall suffer for it.”
“Nay, nay, good Marcus!” answered Elissa, laughing at the young
man’s serious looks, “I need not mine armour for any defensive
purposes, but merely as solid food wherewith to feed yonder hungry
shark. For henceforth I will be a woman only, and mine only defence
shall be my virtue; or, rather,” she continued, smiling bitterly, “so
much of it as King Philip hath left me. I have no longer need for
sword or shield, neither helmet nor cuirass can make me what I was;
no arms, alas! can give me back the self-respect that was mine
before I fell into the clutches of Philip of Macedon; thus I will no more
employ them to slaughter hapless beings who may already,
perchance, have suffered as deeply as I have myself.”
She paused, and furtively wiped away a tear, for she was, indeed,
all woman now. Stooping, she seized upon her helmet, rose, and
cast it overboard.
Like a streak of light did the shark, with gleaming side, dash
through the water. Turning belly upwards, he seized the helmet,
displaying two triple rows of teeth just below them as they stood by
the bulwarks.
 Cleandra screamed at the sight of the horrid monster so close to
her, and seized Marcus tightly by the arm.
“Dost thou see the brute?” quoth Elissa; “he eateth, with the
digestion of an ostrich, everything, no matter of what description, that
falls overboard; I have watched him for days. He would, indeed,
make but one bite of thy sweet rounded form, my dear Cleandra, so
grasp thy Marcus firmly.
“But now,” she continued, “he shall have that I never yet yielded to
living man—and much good may it do him.”
So saying, she cast her bared sword into the water. The savage
brute dashed at it as before, and caught the glittering weapon in its
gigantic maw.
In striving to close its mouth, however, the point entered deeply
into the upper jaw, while the hilt remained against the lower one.
Thus, the huge beast could not close its horrid teeth, but remained
lashing furiously with its tail the waters, which were soon tinged with
blood. Meanwhile, while watching the struggles of the gigantic shark,
Elissa threw over in turn her cuirass and her sheath of darts.
There now remained nought but her shield. Elissa picked this up,
intending that it should follow all the rest. But her hands were
unequal to the deed. As she gazed down upon the golden horse in
its centre, the salt tears fell upon the polished but dinted steel,
wherein she seemed to see as in a mirror all her warlike past, all
those deeds of arms that she was renouncing now for ever.
“Oh, I cannot do it, I cannot do it!” she sobbed. “I cannot cast away
my shield, my last defence, so oft my trusty friend.”
Gently, the loving Cleandra wound an arm round the beautiful
young woman and soothed her, while Marcus Æmilius, embarrassed
beyond measure, and, as a warrior, grieved also at the scene he had
been witnessing, in seeing these arms cast away, turned to the side
of the ship to watch the still struggling tiger of the deep, who, now
that he was in adversity, was being attacked by several others of his
own kind. For some small ground sharks, that had not hitherto
shown themselves, suddenly appeared from the bottom of the bay,
and were savagely tearing away at his defenceless sides, biting out
huge pieces.
 Elissa, recovering herself, pointed out what was taking place to
Cleandra.
“How like humanity! where the little are ever ready to take
advantage of the misfortunes of the great. And how like a warrior
deprived of sword and shield, ay, even like myself, is that now
defenceless monster. But although in future I will be woman, not
warrior, I will not after all cast away that emblem of a warrior’s
defence, for which a woman hath no need.”
She drew herself up proudly, and approached the Roman.
“Marcus Æmilius, since thou art my defence at this moment, and
since, by all the gods! I do most sincerely trust in thine honour, I will
even confer upon thee that which hath been the safeguard of
Hannibal’s daughter from Roman weapons in many a bloody field.
For no need have I, now nought but a mere woman, for a shield,
being under the care of an honourable man. Therefore take thou my
buckler, and keep it, for Elissa’s sake.”
The handsome young ambassador was a most courtly knight. He
threw himself upon one knee to receive the tendered gift. While he
received the shield with one hand he raised the other to heaven in
an invocation.
“May the great god Jupiter destroy me with his thunderbolts, if
ever I should part from this most sacred shield, or should I ever harm
a hair of the head of the most gracious and lovely lady who hath
bestowed it upon me.”
He kissed Elissa’s hand, then rising and holding the shield with all
honour, as though it were an offering consecrated to the gods,
Marcus Æmilius bore it with him to his cabin.
Meanwhile, the little sharks were still tearing the big shark to
pieces, and, as the monster writhed about in its agony, the rays of
the sun were frequently brilliantly reflected from Elissa’s sword blade
fixed upright in the midst of its horrible fangs. But even as Æmilius
disappeared from view, bearing her shield, so with a last convulsive
struggle did the monster sink, followed by its tormentors.
Elissa accepted this as a good omen, a sign that her own troubles
were buried for ever with her sword at the bottom of the sea. And
she felt happier and altogether more womanly now that she had thus
divested herself of her arms and armour.
 The voyage was a long one, owing to the adverse breezes, which
made the crossing of the southern part of the Adriatic impossible for
a time; but at length, the wind changing, the ships were able to issue
from the Grecian land-locked harbour, where they were lying, and
pass swiftly across to the entrance of the Tarentine Gulf, situated
between the Iapygian and Bruttian promontories, which form, as it
were, respectively the heel and the toe of the south of Italy.
As the ships sailed in, the day being remarkably clear, Æmilius
pointed out to Elissa and Cleandra something white glistening on the
hill-tops to the far west across the gulf. This, he informed them, was
the celebrated temple of Juno Lacinia, which was held most sacred
by all, and especially by seamen, as it formed a landmark for them to
steer by. What neither Æmilius nor Elissa knew, however, was that
Hannibal her father was at that very time encamped with his forces
in the sacred groves and parks surrounding the temple. For he had
made of that spot, known as the Lacinian Promontory, his head-
quarters.
Although some Carthaginian vessels were sighted in the distance,
and Æmilius had some anxiety in consequence, he managed to
elude them, and to arrive with his three ships safely within the
harbour of Tarentum. Before entering the harbour, a great part of the
town had been passed, and Elissa noticed that it had a miserable
and deserted look. This was not surprising, for, upon its recent
delivery by treachery to the Romans, thirty thousand of its Greek
inhabitants had been sold into slavery, while all its Bruttian
inhabitants had been massacred. Moreover, all the famous statues
and works of art in the city had been taken away to Rome.
 CHAPTER II.
ELISSA WRITES TO SCIPIO.

When the three Roman warships were safe within the shelter of the
harbour, the entrance to which was completely dominated by the
citadel, now full of Roman soldiers, the first thing that was pointed
out to Elissa was the place where her father Hannibal had, by night,
some years previously, withdrawn the Tarentine fleet from the waters
and conveyed the whole of the ships on wheels and rollers across
the isthmus into the open seas without. At the same time Æmilius
dwelt with pride upon the fact that, although Hannibal had entered
the town by the treachery of two of its inhabitants to Rome, and
eventually lost it again by the treachery of its commander to
Carthage, yet had her father never been able to capture the citadel,
notwithstanding his several years’ occupation of the city.
The arrival of the young ambassador and his squadron created no
slight stir in the place, and the three quinquiremes had no sooner
cast anchor than the Roman governor of the town, one Caius
Tacitus, lost no time in coming off in his State barge to visit the
envoy, and to learn the latest tidings from the court of Philip.
When the governor found that Elissa was on board, as the friend,
not the prisoner of Marcus Æmilius, his surprise knew no bounds.
Nor was his surprise modified when he learned that Hannibal’s
daughter was on her way to Rome to marry Scipio. Withholding any
news of Italian matters until later, Caius invited Marcus and his
guests to come ashore without delay, when he entertained them right
royally to a banquet in the citadel.
It was during this banquet that Elissa became aware of two
circumstances. The first was that her father was encamped with his
forces somewhere in the Bruttian Peninsula, at some point probably
within a hundred Roman miles of where she then was; the second
that, despite his youth, Scipio had been elected consul for the year,
and had been recently despatched into Sicily. Thither he had been
sent with two Roman legions as a nucleus, and was now busy
raising a large army from various sources and building a fleet with
which to cross over the sea to Carthaginian soil.
This information gave Elissa much cause for reflection; for it was,
indeed, thoroughly calculated to arouse all kinds of conflicting
feelings in her mind.
The calm which had so recently existed in her breast was already
disturbed, and once again all was riot and chaos within. For her duty
now scarcely seemed so clear to her as it had been, when all that
was required of her was to go straight to Rome and join Scipio, and
when she had had no idea of her own father’s likely proximity. She
wondered now if it were not rather her duty to endeavour by some
means or other to join her father.
That night, after her return to the ship, she pondered long on the
subject, nor would she hold any converse with Cleandra, who was
anxious to know how Elissa had taken the news. Her she sent to talk
with Æmilius, while keeping apart herself in a separate part of the
ship. And thinking of her father’s many exploits, by one alone of
which this very city of Tarentum was to be for ever celebrated, she
remained gazing into the night, and most ardently did Elissa offer up
her prayers to the great god Melcareth that he would guide her in
this juncture. She was not weighing in her mind the possibility of
carrying out any plan of escape to her father’s camp, but rather that
which would be right and just for her to do in the sight of heaven. At
length light came to her brain and her course seemed clear.
Evidently she was bound more than ever now to fall in with Scipio’s
wishes; bound in honour to him, for was she not now by his means
safely removed from the clutches of the detested Philip? and, more
than ever, for the very sake of Carthage, for, while the Phœnician
power was diminishing to a vanishing point all over the world, the
power of Rome was ever increasing by leaps and bounds.
Further, since Scipio had, in addition to all the honours he had
won, now been appointed consul, he would be in a far better position
to make himself heard before the Senate in a matter of peace and
war. Moreover, the invasion of Carthage clearly depended in a great
measure upon him alone, since he had only been provided with two
legions to start with, which legions consisted merely of the runaways
from the battle of Cannæ, who had been kept for punishment in