The Science of the Total Environment 249 Ž2000. 243]256 Deposition and disease: a moss monitoring project as an approach to ascertaining potential connections O. WappelhorstU , I. Kuhn, ¨ J. Oehlmann, B. Markert International Graduate School Zittau, Markt 23, 02763 Zittau, Germany Abstract In the years 1995 and 1996 the atmospheric deposition of elements in the EuroRegion Neisse ŽERN. was determined in a biomonitoring project using mosses. The mosses Pleurozium schreberi and Polytrichum formosum were chosen as biomonitors because of their wide distribution in the area studied. The moss samples were analysed by ICP-MS and ICP-OES for their concentrations of 37 chemical elements. The results were shown in the form of maps. The data from the moss monitoring project served as a basis for determining those elements in the deposited material that promote the occurrence of disease. This was done by correlating the figures for the various diseases with the appropriate element concentrations in the mosses. Indications were found that a connection exists between the thallium content of mosses and the occurrence of cardiovascular disease and between Ce, Fe, Ga and Ge levels in the mosses and the incidence of diseases of the respiratory system. Q 2000 Elsevier Science B.V. All rights reserved. Keywords: Atmospheric pollution; Biomonitoring; Deposition; Disease; Human health; Moss; Pleurozium schreberi; Polytrichum formosum 1. Introduction Air pollution is known to be detrimental to human health, but it is very difficult to prove a connection between a specific pollutant and a disease. Such proof can only be furnished on the U Corresponding author. E-mail address: [email protected] ŽO. Wappelhorst. basis of data on atmospheric pollution and the incidence of disease in a particular region. In general, expensive and delicate measuring instruments are used to ascertain the pollutant input in a region. Such instruments have to be installed in a measuring network, which ties up personnel and is costly to use and maintain. As a result, quantitative and qualitative monitoring of the pollutants can only be carried out at a few selected locations by this method. Biomonitoring 0048-9697r00r$ - see front matter Q 2000 Elsevier Science B.V. All rights reserved. PII: S 0 0 4 8 - 9 6 9 7 Ž 9 9 . 0 0 5 2 1 - 5 244 O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 Fig. 1. Paths by which pollutants are taken in by human beings and moss. Unlike mosses, human beings are exposed to pollutants in numerous places and take substances in by several routes. is a more elegant, indirect method of determining the pollutants and their distribution. It makes use of the plants’ ability to accumulate pollutant subs- tances over a considerable period of time. This makes it possible to determine pollution of the environment at the site of a plant, e.g. a moss, as Fig. 2. EuroRegion Neisse, where the three states Germany, Poland and the Czech Republic meet. O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 a function of time without the risk that the results will be distorted by short-term fluctuations ŽMarkert et al., 1999.. Besides damaging the environment, the deposition of chemical elements in all manner of forms and compounds may also impair human health. To determine which elements promote the occurrence of specific diseases it is necessary to compare the incidence of the disease with the element concentrations in atmospheric deposits. A biomonitoring project using mosses was carried out to measure this input of elements. To make it easier to detect the differences in pollution within the study area, the data were presented in the form of contour maps. Whereas atmospheric deposition is the main source of the substances taken up by the mosses used as biomonitors in this survey it is only one of several paths by which such substances can be taken in by human beings; its share of the overall intake depends on the individual’s personal circumstances and way of life ŽFig. 1.. The EuroRegion Neisse ŽFig. 2. was chosen as a model for the survey. It is situated at the point where three countries } Germany, the Czech Republic and Poland } meet. Until the early 1990s this area was infamous for its high pollution level. The burden on the environment has since been reduced considerably through the closing of numerous industrial facilities and Hagenwerder Power Station, the fitting of modern filters at the brown coal power stations ŽBoxberg, Turow ´ . and the replacement of old power station units by new ones ŽBoxberg, Schwarze Pumpe. ŽWappelhorst et al., 1999.. A further source of emissions is the metal-working and glass industry in the Liberec ˇ ´ Lıpa and Ceska ´ area. The plants chosen as biomonitors were the mosses Pleurozium schreberi and Polytrichum formosum. The use of epiphytic plants as passive biomonitors is an established method of determining atmospheric deposition. In Scandinavia, mosses have been used as biomonitors for determining pollution with heavy metals since the late 1960s ŽRuhling and Tyler, 1968.. Numerous ¨ projects have since been carried out with mosses; the method has been developed systematically ŽEllison et al., 1976; Maschke, 1981; Engelke, 245 1984; Steinnes, 1984; Ross, 1990. and also used in large-scale European studies ŽRuhling, 1994; Her¨ pin, 1997.. It is mainly the endohydric mosses Pleurozium schreberi and Hylocomium splendens that have been used in these studies. The bryophytes can be divided into two groups } the ectohydric and endohydric types } according to the manner in which they take up and transport water ŽBuch, 1947a,b.. Ectohydric mosses do not have differentiated internal conductive tissue. Water is transported by capillary forces between the stem and the leaves closely adhering to it. Such mosses have no cuticle. Endohydric mosses such as Polytrichum formosum have an efficient internal water transportation system and a thin cuticle. In both types, nutrients are taken up in the same way as water ŽBuch, 1947a; Proctor, 1984.. Both ectohydric and endohydric mosses draw their nutrients almost solely from precipitation and not from the soil through their root-like rhizoids, which only serve to anchor the plants to the substrate. Moss analyses were used to determine the occurrence and distribution of the elements Ag, Al, Ba, Be, Bi, Ca, Cd, Ce, Co, Cr, Cs, Cu, Fe, Ga, Ge, K, La, Mg, Mn, Mo, Na, Nd, Ni, Pb, Pr, Rb, Sn, Sr, Ti, Tl, Th, U, V, Y, Zn and Zr in the EuroRegion Neisse ŽERN. ŽWappelhorst, 1999.. Little is known about the environmental concentrations and distribution of some of these elements, such as Ce, La, Nd, Y and Zr, but their industrial significance as constituents of alloys, semiconductors and catalysts has increased in recent years. 2. Materials and methods 2.1. Sampling The samples were collected over a period of 4 weeks from mid August to mid September in the years 1995 and 1996. The sampling procedure followed that of the pan-European moss monitoring project ŽRuhling, 1994., which requires that ¨ moss samples be taken from the soil in open areas, preferably forest clearings. The sampling sites should be at least 300 m from the nearest 246 O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 major road, townrvillage or industrial facility and at least 100 m from smaller country roads and individual houses. To avoid the direct influence of water dripping from the leaf canopy, the minimum distance from the nearest tree must be 5 m. Several sub-samples were taken in an area of 50 = 50 m at each sampling site. PE gloves were worn to prevent contamination during sampling and further work on the plants. In the laboratory the dirt adhering to the samples was removed and the green and brown parts of the plants were separated. In the case of Pleurozium schreberi the green parts are the growth of the last 2]3 years. The age of Polytrichum formosum can be determined by the antheridium cups through which the plant has grown; the growth of the last 2 years was used for analysis. The unwashed samples were dried at 458C and then homogenised in a disk vibration mill with a wolfram carbide container. material ŽPeach Leaves SRM 1547 or Cabbage GBW 08504. was carried out in each series as a control for the analytical results ŽMarkert, 1996.. The equipment used for analysis was ICP-MS ŽPerkin Elmer, ELAN 5000. and ICP-OES ŽPerkin Elmer, Optima 3000.. All standards, blanks and samples contained 3% HNO3 and also 50 ngrml Sc, Rh and Ir as an internal standard. 2.2. Instrumental analysis Yj s f The samples Ž300 mg. were subjected to microwave-assisted pressure digestion with 4.0 ml of concentrated nitric acid Žsuprapur. and 2.0 ml of hydrogen peroxide Žsuprapur. in closed PTFE vessels. After cooling, the samples were made up to 50.0 ml. A digestion with certified reference žÝ / 2.3. Mapping Inverse Distance Weighting ŽIDW. was used as a method for interpolating the element concentrations in terms of space. The interpolation was carried out with the aid of the Geographic Information System ARCrINFO W using the IDW interpolation function in the grid module according to the following formula: Formula 1: i Yj s value of the grid cell d i js Distance between the measuring point and the relevant grid cell 1 x di j z i z s 1.8 ŽThe exponent may take the ¨ alues 0.5]3. A higher ¨ alue means less influence of distant measurements.. A grid with cells 350 = 350 m in size is defined Table 1 Classification of the diseases studied according to ICD 9 ICD 9 Description of the disease 140]208 162 172, 173 204]208 390]459 393]398, 410]429 410 411]414 401]405 430]438 460]519 480]486 466, 490, 491 490]496 493 680]709 710]739 Neoplasms Malignant neoplasms of the trachea, bronchus and lung Malignant melanomas of the skin and other malignant neoplasms of the skin Leukaemia Diseases of the circulatory system Heart diseases Acute myocardial infarction Other forms of ischaemic heart disease Essential and secondary hypertension Diseases of the cerebrovascular system Diseases of the respiratory system Pneumonia Bronchitis Chronic obstructive lung disease Asthma Diseases of the skin and subcutaneous tissue Diseases of the musculoskeletal system and connecti¨ e tissue O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 Table 2 The European Standard Population according to Waterhouse Ž1976. Age group 0 1 to 5 to 10 to 15 to 20 to 25 to 30 to 35 to 40 to 45 to 50 to 55 to 60 to 65 to 70 to 75 to 80 to 85 q -5 - 10 - 15 - 20 - 25 - 30 - 35 - 40 - 45 - 50 - 55 - 60 - 65 - 70 - 75 - 80 - 85 Total Europe 1600 6400 7000 7000 7000 7000 7000 7000 7000 7000 7000 7000 6000 5000 4000 3000 2000 1000 1000 100 000 to cover the area between the points, and the seven closest measuring points are used for calculating the value of each cell. The value calculated for a grid cell depends on the element concentrations at the surrounding measuring points and also on the distance between these values and the grid cell concerned. A detailed description of the interpolation technique is to be found in Watson and Philip Ž1985.. For mapping, the element concentrations were divided into five classes using the method of Erhardt et al. Ž1996.. Initially, a standard value is formed that incorporates a homogeneous group of low values. These values } and the standard value thus formed } reflect the background concentration. Three further classes lie above these standard values, and a further class comprises lower concentrations. 2.4. Impact on human health Air-borne pollutants are inhaled by man and chiefly cause chronic diseases of the upper and lower respiratory tract. At high concentrations 247 they may also cause acute disorders. After inhalation the various components may have synergistic effects, with the result that their overall impact is greater than the sum of the effects of the individual substances ŽBerenbaum, 1985; Spurny, 1993.. The substances entering the lungs may be taken up by the blood and metabolised. Air pollutants are said to be responsible for 1]5% of all additional cases of cancer ŽDoll and Peto, 1981. and, according to some estimates, 11]21% of all cases of lung cancer are caused by air pollution ŽKarch and Schneiderman, 1981.. Doll and Peto Ž1981. and Karch and Schneiderman, 1981. investigated the health hazard resulting from the total aerosol of the atmosphere. They did not consider its composition and the proportions of the individual substances. These were first investigated by Spurny Ž1993., who compared industrial, residential and clean-air regions in his study. An investigation into the effects of atmospheric pollution on individuals over large areas involves the collection of data throughout the region. Biomonitoring is an excellent means of doing this. Such an approach was used by Cislaghi and Nimis Ž1997. in a study in which they compared mortality from various pulmonary diseases with a biodiversity index for lichens. High correlation coefficients were found between the index and the number of deaths from lung cancer. However, no direct conclusions were drawn in respect of levels of individual elements. The present study was to be the first attempt to compare pollution with numerous elements } detected by using mosses as biomonitors } with the incidence of disease. The numbers of patients discharged from hospitals, including deaths, in the years 1993]1997 were taken as the basic data for the frequency with which a disease occurs. In Germany this data, which includes the diagnosis and the patient’s sex, age and place of residence, is passed on from the hospitals to the Statistical Offices of the individual states every year. The diseases are classified according to ICD 9 ŽInternational Statistical Classification of Diseases and Related Health Problems, ninth revision, WHO. ŽTable 1.. 248 O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 We were able to evaluate the data from the districts of Bautzen, Kamenz, Lobau]Zittau, the ¨ Upper Lusatia district of Lower Silesia ŽNOL. and the county boroughs of Gorlitz and Hoyer¨ swerda. The data are classified according to sex and age Ž0 to - 5, 5 to - 10, . . . , 80 to - 85, 85 and over.. The age structure, which has a bearing on the incidence of disease, differs from one area to another. In order to compare the disease figures for the individual areas nevertheless, it was necessary to standardise them. Two possible methods of standardisation were available. In the first method the data were converted in accordance with the European Standard Population Žsee Tables 1 and 2. ŽWaterhouse, 1976.. The age groups are taken into account in the standardised overall incidence of a disease with a weighting that corresponds to their share of the standard population. In the second method the numbers of cases of the disease are converted to a figure per 100 000 inhabitants divided up according to sex and age; the overall incidence of the disease per 100 000 inhabitants is then calculated. This method has the advantage that the data can be evaluated separately according to age and sex. But such a breakdown can lead to very small case numbers per group and thus, cause major errors in the results. This does not happen with the first method. A further advantage is a great reduction of the individual data to be processed. 2.5. Distribution of elements in the EuroRegion Neisse Figs. 3]8 are examples showing the interpolated concentrations of the elements Ce, Cr, Nd, Sn and Tl in Polytrichum formosum and the interpolated thallium concentrations in Pleurozium schreberi. Concentrations exceeding the standard value were found for the elements Ce, Cr and Nd shown in the figures and also for Fe, Ge, La, Li, Nb, Ni, Pr, Th, Ti, U, V and Zr north of Turow ´ Power Station, along the valley of the Neisse, across the Liberec region and as far as the south of the ERN. The other elements investigated have different distribution patterns. The differences in distribution patterns found between Polytrichum formosum and Pleurozium schreberi can be explained by the morphological and physi- Fig. 3. Cerium concentration in mgrg dry matter in Polytrichum formosum. O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 Fig. 4. Chromium concentration in mgrg dry matter in Polytrichum formosum. Fig. 5. Neodymium concentration in mgrg dry matter in Polytrichum formosum. 249 250 O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 Fig. 6. Thallium concentration in mgrg dry matter in Polytrichum formosum. Fig. 7. Thallium concentration in mgrg dry matter in Pleurozium schreberi. O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 251 Fig. 8. Tin concentration in mgrg dry matter in Polytrichum formosum. ological differences between the plants ŽWappelhorst, 1999.. An influence of the soil on the element concentrations was not detected for either of the mosses. In the ERN, the atmospheric deposition reflected in the element concentrations in the two moss species is similar to that found in moderately to slightly polluted regions of Europe as a whole ŽWappelhorst et al., 1999.. Exceptions to this are those elements whose main source of emission is the burning of brown coal. Since brown coal deposits exist in the ERN, this fuel is one of the major sources of energy in the region. 2.6. Disease and atmospheric deposition To determine possible connections between deposition and disease, the incidence of the diseases was correlated with the element concentrations in the mosses. The concentrations of a number of elements in the mosses Pleurozium schreberi and, to a lesser extent, in Polytrichum formosum differ only slightly from one sampling site to another in the ERN. A priori, high correlation coefficients would result between these elements and all diseases that also show little geographic difference in incidence. But such correlations yield extremely little information; for this reason, only elements with a mean relative deviation of at least 35% from the median were considered. In the ERN, differences of this magnitude were found for Ag, Al, Be, Bi, Ce, Cr, Cs, Fe, Ga, Ge, La, Li, Mn, Mo, Na, Nb, Nd, Pb, Pr, Rb, Sn, Th, Ti, Tl, U, V, Y and Zr in Polytrichum formosum and for Be, Bi, Cs, Mn, Na and Tl in Pleurozium schreberi. The incidences of disease converted in accordance with the standard population ŽMethod 1. and the numbers of cases broken down according to age and sex ŽMethod 2. were correlated with the element concentrations in the moss samples from the various districts. The results are similar; for this reason, the results of Method 2 are only given in part. Significant correlations Ž PF 0.1. between the element concentrations in the mosses and the incidence of the diseases covered by the survey are shown in Table 3. For the sake of simplicity 252 O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 Be Bi Cs Mn Na Tl a 20]25 25]30 30]35 35]40 40]45 45]50 50]55 55]60 60]65 65]70 70]75 75]80 80]85 ) 85 y0.10 0.33 0.46 0.14 0.46 0.49 y0.22 0.38 0.54 y0.23 0.07 0.39 y0.02 y0.13 y0.10 0.63 0.75 y0.08 y0.18 y0.08 0.13 0.44 0.78 0.20 y0.14 0.44 0.61 y0.07 0.31 0.63 y0.08 0.45 0.60 y0.33 0.10 0.71 y0.01 0.01 0.11 0.29 0.66 0.19 y0.18 0.20 0.42 y0.09 0.36 0.44 y0.12 0.59 0.76 y0.36 0.05 0.81 y0.03 0.76 0.85 y0.57 y0.25 0.96 y0.12 0.69 0.84 y0.48 y0.12 0.92 y0.05 0.81 0.90 y0.60 y0.31 0.98 y0.10 0.82 0.94 y0.63 y0.36 0.99 y0.05 0.86 0.92 y0.71 y0.49 0.99 Significant correlation coefficients are printed in bold type. Be Bi Cs Mn Na Tl O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 Table 4 Coefficients of correlation between the incidence of essential and secondary hypertension ŽICD 401]405. and element concentrations in Pleurozium schreberi in the years 1993]1997, broken down according to age groupsa 253 254 ICD 9 - 1]5 5]10 10]15 140]208 y0.50 0.30 162 y0.68 172, 173 0.37 204]208 y0.30 I0.80 390]459 y0.27 y0.24 0.22 393]398, y0.37 I0.73 I0.75 410]429 401]405 410 411]414 y0.68 0.73 430]438 0.88 y0.68 y0.68 460]519 0.24 y0.53 0.55 466,490, y0.05 y0.34 y0.42 491 480]486 0.23 0.05 0.27 490]496 0.46 0.48 0.87 493 0.51 0.45 0.84 680]709 0.74 0.68 0.51 710]739 0.67 0.41 0.59 a 30]35 35]40 40]45 60]65 65]70 70]75 80]85 ) 85 y0.29 y0.14 I0.76 0.20 y0.20 y0.14 y0.68 0.84 0.26 0.67 0.10 0.25 y0.53 0.75 y0.26 y0.65 0.67 0.64 0.82 0.42 y0.52 y0.45 0.59 0.48 0.42 y0.13 0.81 0.04 0.46 0.55 y0.15 y0.20 y0.30 y0.07 0.32 y0.36 0.56 0.77 0.12 0.59 0.30 y0.40 y0.11 y0.51 0.30 0.02 0.36 y0.13 y0.65 y0.33 0.71 0.72 0.14 0.65 0.92 0.66 0.57 y0.06 0.45 0.89 0.05 0.09 0.07 y0.68 0.66 0.48 y0.41 y0.36 0.73 0.22 0.58 y0.19 0.83 y0.01 0.46 y0.65 y0.67 y0.34 0.82 0.78 0.86 0.81 0.64 0.74 0.71 0.36 0.79 0.52 0.72 0.49 15]20 20]25 25]30 y0.40 y0.23 0.12 0.25 0.90 0.31 y0.64 y0.41 y0.21 y0.21 0.79 0.85 0.94 0.74 0.22 0.40 0.56 0.70 0.69 0.17 0.28 0.85 0.60 0.91 0.76 0.19 0.39 0.65 0.34 0.59 0.64 0.16 0.33 0.58 0.62 0.68 0.78 0.46 0.07 0.80 0.91 0.33 0.24 0.52 0.73 0.21 0.47 0.55 0.59 0.74 0.56 0.78 0.21 0.90 0.77 0.75 0.65 0.59 0.66 45]50 50]55 0.65 0.64 0.88 0.58 0.37 y0.17 0.42 0.21 0.78 0.88 0.81 0.86 0.75 0.78 0.54 0.31 y0.58 y0.11 0.38 0.73 0.10 0.31 55]60 0.83 0.82 0.74 0.60 0.64 0.48 0.69 0.91 0.72 0.42 0.84 0.87 0.75 0.87 0.94 0.45 0.86 0.74 0.55 0.56 0.42 0.76 0.71 0.56 0.39 y0.03 y0.01 0.21 y0.09 0.60 0.08 y0.15 0.05 0.64 0.85 y0.22 0.72 0.14 0.40 0.75 y0.57 0.51 0.43 Significant coefficients are printed in bold type. For classification according to ICD 9, see Table 1. 0.66 0.81 0.76 0.68 0.90 0.75 75]80 0.70 0.90 0.93 0.45 0.66 0.70 0.70 0.92 0.87 0.66 0.76 0.73 0.61 0.88 0.80 0.66 0.60 0.36 0.53 0.63 0.52 0.73 0.93 0.63 0.27 y0.36 y0.17 0.39 0.80 0.59 0.29 0.25 0.62 O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 Table 5 Coefficients of correlation between thallium concentrations in Polytrichum formosum and the incidence of diseases in ERN a O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 the remaining correlation coefficients are not included. The fact that a disease is caused or promoted by increased rates of deposition of an element would be reflected in a positive correlation; positive correlation coefficients are therefore, printed in bold type. Negative correlations may be interpreted as a ‘protective effect’ of an element against the disease concerned. Correlations between the incidence of diseases and the mean element concentrations in the moss samples from each district. Only significant correlation coefficients Ž PF 0.1. are shown; positive correlation coefficients are printed in bold type. The concentrations of the elements Ce, Fe, Ga and Ge in Polytrichum formosum correlate significantly with the incidence of malignant neoplasms of the trachea, bronchus and lung ŽICD 162. and the incidence of diseases of the skin and subcutaneous tissue ŽICD 680]709.. There is a significant positive correlation between the thallium concentrations detected in the moss Polytrichum formosum and the incidence of diseases of the circulatory system in general ŽICD 390]459.; in particular there is a correlation with essential and secondary hypertension ŽICD 401]405., acute myocardial infarction ŽICD 410., other forms of ischaemic heart disease ŽICD 411]414. and chronic obstructive lung disease ŽICD 490]496.. The Tl concentration in Pleurozium schreberi also correlates significantly with the incidence of essential and secondary hypertension ŽTable 3.. The evaluation according to age groups ŽMethod 2. gives a very clear indication of the connection between Tl concentrations and the occurrence of acute myocardial infarction and hypertension in the age groups over 40 Ž Pleurozium schreberi, Table 4. and over 25 years of age Ž Polytrichum formosum, Table 5.. In the older age groups there are highly significant correlations for both men and women. Since Tl and K have a similar ionic radius Ž150 and 151 pm, respectively., Tl has an effect on the conduction system of the heart and the cardiac muscle ŽMarquart and Schafer, 1997.. ¨ Table 4 shows the coefficients of correlation between essential and secondary hypertension ŽICD 401]405. and the element concentrations in Pleurozium schreberi. 255 Table 5 shows the results of correlating the thallium concentration in Polytrichum formosum with the diseases in the ERN. Significant correlations were found between concentrations of the elements Nd, Sn and Th in Polytrichum formosum and the incidence of leukaemia ŽICD 204]208.. In contrast to this, the correlation coefficient for Tl is significantly negative. Practically nothing is known about the toxicity of Nd. The toxicity of inorganic tin compounds is generally considered to be low, but tin organyls are suspected of having a carcinogenic effect ŽOehlmann and Markert, 1997.. Thorium may have a carcinogenic effect because of its radioactivity. Chromates are carcinogenic; they mainly cause tumours of the nose and lungs ŽMarquart and Schafer, ¨ 1997; Oehlmann and Markert, 1997.. The Cr concentrations detected in Polytrichum formosum show a positive but not significant correlation Ž r s 0.63. with the malignant neoplasms of the trachea, bronchus and lung ŽICD 162.. Significant correlations were found between the concentrations of such elements as Ce, Fe, Ga and Ge in the biomonitors and diseases of the respiratory tract. Cerium may be regarded as non-toxic, and Fe is essential to all organisms. Gallium is slightly toxic and has a stimulant effect like that of Ce. Germanium is also thought to be non-toxic, but some Ge compounds are poisonous. These elements are found in dust deposits. Their sources are the burning of fossil fuels and the drifting of dust on the ground. High Fe concentrations in the mosses indicate a generally high level of pollution with dust, which may result in respiratory tract disease. 3. Summary and evaluation This is the first study comparing pollution with numerous elements, determined by moss monitoring, with the incidence of various types of disease. For most of the elements, the region studied was found to have a level of pollution similar to that of many other European regions. This means that it may be regarded as a model case. 256 O. Wappelhorst et al. r The Science of the Total En¨ ironment 249 (2000) 243]256 Since the elements are taken in chiefly by inhalation, a connection between pollution and diseases of the respiratory tract was to be expected. A connection was indeed found between such diseases and levels of the elements Ce, Fe, Ga and Ge in the mosses. Unexpectedly, a correlation was also proved to exist between thallium concentrations and heart disease. In the case of some other elements, such as Cr, there seems to be a connection with certain diseases but no significant correlation was observed. The reason may be that the element concentrations in the deposits are only one of many factors involved in pollution. Other factors, such as indoor air contaminants or personal habits, may overlay the effects of atmospheric deposition. The significant correlations found between the element concentrations in the mosses Pleurozium schreberi and Polytrichum formosum and the incidence of a disease can only provide indications as to the possible causes of the disease. Causality is not taken into account when the correlation coefficients are calculated. This means that correlations can never prove that a connection exists. To do so will be the task of further studies, for which these results may offer initial hints. References Berenbaum MC. Consequences of synergy between environmental carcinogenesis. Environ Res 1985;50:310]318. ¨ Buch H. 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