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Drinking Water and Health Volume 4 SAFE DRINKING WATER COMMITTEE Board on Toxicology and Environmental Health Hazards Assembly of Life Sciences National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1982

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the Councils of the Na- tional Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the Committee responsible for the report were chosen for their competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Research Council was established by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's pur- poses of furthering knowledge and of advising the federal government. The Council operates in accordance with general policies determined by the Academy under the authority of its congressional charter of 1863, which establishes the Academy as a private, nonprofit, self- governing membership corporation. The Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in the conduct of their services to the government, the public, and the scientific and engineering communities. It is administered jointly by both Academies and the Institute of Medicine. The National Academy of Engineering and the Institute of Medicine were established in 1964 and 1970, respectively, under the charter of the National Academy of Sciences. At the request of and funded by the U.S. Environmental Protection Agency, Contract No. 68-01-3169 Library of Congress Catalog Card Number 77-089284 International Standard Book Number 0-309-03198-2 Available from NATIONAL ACADEMY PRESS 2101 Constitution Ave., N. W. Washington, D.C. 20418 Printed in the United States of America First Printing, April 1982 Second Printing, October 1985 Third Printing, December 1988

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List of Participants SAFE DRINKING WATER COMMITTEE JOHN DOULL, University of Kansas Medical Center, Kansas City, Kansas, Chairman JULIAN B. ANDELMAN, University of Pittsburgh, Pittsburgh, Pennsylvania DONALD R. BALER, Oregon State University, Corvallis, Oregon WILLIAM G. C~RACKLIS, Montana State University, Bozeman, Montana RUSSELL F. CHRISTMAN, University of North Carolina, Chapel Hill, Nodh Carolina STEVEN D. COHEN, University of Connecticut, Storrs, Connecticut RICHARD S. ENGELBRECHT, University of Illinois, Urbana, Illinois A. WALLACE HAYES, Rohm & Haas Company, Spring House, Penn Sylvania NAMES M. HUGHES, Centers for Disease Control, Atlanta, Georgia VINCENT P. OLIVIERI, The Johns Hopkins University, Baltimore, Maryland MALCOLM C. PIKE, University of Southern California Medical School, Los Angeles, California R. CRAIG SCHOOL, University of Nebraska Medical Center, Omaha. Nebraska JOSEPH C. SWEET, Utah State University, Logan, Utah CAROL H. TATE, James M. Montgomery Consulting Engineers, Inc., Pasadena, California ...

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iV LIST OF PARTICIPANTS National Research Council Staff RILEY D. HOUSES, Project Director ROBERT I. GOLDEN, Staff Officer FRANCES M. PETER, Editor BARBARA JAFFE, Information Specialist EPA Project Officer KRIS~N ANNA, Office of Water Supply, U.S. Environmental Protec- tion Agency, Washington, D.C. BOARD ON TOXICOLOGY AND ENVIRONMENTAL HEALTH HAZARDS RONALD W. ESTABROOK, University of Texas Medical School (South- western), Dallas, Texas, Chairman THEODORE CAIRNS, DuPont Chemical Co. (retired), Greenville, Delaware VICTOR COHN, George Washington University Medical Center, Wash- ington, D.C. JOHN W. DRAKE, National Institute of Environmental Health Sciences, Re- search Triangle Park, North Carolina ALBERT M. EN, Bowdoin College, Brunswick, Maine RICHARD ~L, McCormick & Company, Hunt Valley, Maryland RONALD W. HART, National Center for Toxicological Research, Jefferson, Arkansas PHILIP LA~RIGAN, National Institute for Occupational Safety and Health, Cincinnati, Ohio MICHAEL LIEBER~N, Washington University School of Medicine, St. Louis, Missouri BRLAN MACMAHON, Harvard School of Public Health, Boston, Massachu- setts RICHARD MERRILL, University of Virginia, Charlottesville, Virginia ROBERT A. NEAL, Chemical Industry Institute of Toxicology, Re- search Triangle Park, North Carolina I~ MSBET, Massachusetts Audubon Society, Lincoln, Massachusetts CHARLES R. SCHUSTER, Hi., University of Chicago, Chicago, Illinois GERALD WON, Massachusetts Institute of Technology, Cambridge, Massachusetts ROBERT G. TARDI", National Research Council, Washington, D. Executive Director

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. . . The man they called Ed said the muddy Mississippi water was whole- somer to drink than the clear water of the Ohio; he said if you let a pint of this yeller Mississippi water settle, you would have about half to three- quarters of an inch of mud in the bottom, according to the stage of the river, and then it warn's no better than Ohio water what you wanted to do was to keep it stirred up and when the river was low, keep mud on hand to put in and thicken the water up the way it ought to be. The Child of Calamity said that was so; he said there was nutritiousness in the mud, and a man that drunk Mississippi water could grow corn in his stomach if he wanted to. He says: 'You look at the graveyards; that tells a tale. Trees won't grow worth hil~kc in ~ Cincinnati or~v~v~rt1 hilt in a Sent Louis graveyard they grow upwards of eight hundred foot high. It's all on account of the water the people drunk before they laid up. A Cincinnati corpse don't richen a soil any.' MARK TWAIN Life on the Mississippi v

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Preface The Safe Drinking Water Act of 1974 (PL 93-523) authorized the U.S. Environmental Protection Agency (EPA) to establish federal standards to protect humans from harmful contaminants in drinking water and to es- tablish a joint federal-state system for assuring compliance with these standards and for protecting underground sources of drinking water. One section of the law [1412(e)] and its amendments (42 USC Subpart 300f et seq., 1977) mandated that the National Academy of Sciences conduct studies on the health effects associated with contaminants found in drink- ing water. It stipulated that these studies evaluate the available data for use in developing primary drinking water regulations, identify areas of in- sufficient knowledge, and make recommendations for future research. Amendments to the act in 1977 called for revisions of the studies "reflec- ting new information which has become available since the most recent previous report [and which] shall be reported to the Congress each two years thereafter." The first study in this series was published in 1977 under the title of Drinking Water and Health. That volume examines the health effects associated with microbiological, radioactive, particulate, inorganic, and organic chemical contaminants found in drinking water. Volumes 2 and 3 of Drinking Water and Health were published in 1980. Volume 2 com- pares the efficacy and practicability of chlorination and 11 alternative disinfection methods for inactivating microorganisms, identifies the by- products likely to be formed by the use of each major method, and evaluates the use of granular activated carbon for the reduction or .. vll

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Viii PREFACE removal of organic and other contaminants from drinking water. Volume 3 reviews 12 epidemiological studies-concerning health effects associated with drinking water containing trihalomethanes. It also summarizes the current state of knowledge on the relationship between cardiovascular disease and water hardness. It adds to the 1977 publication's information on estimation of risk to human health by extrapolating data from ex- perimental animals to humans and also evaluates six models for the estimation of carcinogenic risk at low doses. Furthetn~ore, it evaluates the acute and chronic health effects associated with the products of water disinfection and other selected contaminants. One section examines the contribution of selected inorganic elements in drinking water to the op- timal nutrition of humans. The current study (Volume 4) identifies chemical and biological con- taminants associated with drinking water distribution systems and the health implications of deficiencies in those systems. It also contains an evaluation of information on the toxicity of selected inorganic and organic contaminants. Some of them are reviewed for the first time in this report; others were reviewed in earlier volumes of this series. For the latter, discussions include only information that has become available since the earlier reports. A reevaluation of the most recent information on the relationship be- tween water hardness and cardiovascular disease was postponed pending publication of results from several important studies that were presented in an EPA-sponsored symposium at the University of Massachusetts at Amherst in 1979. On behalf of the members of the present committee and all of the members of the previous Safe Drinking Water Committees, I would like to express our gratitude and appreciation for the special efforts of Dr. Riley Housewright, who has sewed as the Project Officer for the safe drinking water studies since their inception in 1975. We wish him the very best in his new position as Executive Director of the American Society for Microbiologr. We also thank Dr. Robert Golden, who completed this project after Dr. Housewright's departure, and Ms. Frances Peter, who served as Editor of the present book. We recognize Ms. Virginia White, Edna Paulson, and Barbara Jaffe, who assisted in the search of the scientific literature and reference verification. We also acknowledge the assistance of members of the EPA staff, especially Drs. Krishan Khanna and Joseph Cotruvo. JOHN DOULL, Chairman Safe Drinking Water Committee

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Contents I EXE C UTIVE S UMMARY II ELEMENTS OF PUBLIC WATER SUPPLIES III CHEMICAL QUALITY OF WATER IN THE DISTRIBUTION SYSTEM IV BIOLOGICAL QUALITY OF WATER IN THE DI STRIBUTION SYSTEM V HEALTH IMPLICATIONS OF DISTRIBUTION SYSTEM DEFICIENCIE S VI TOXICITY OF SELECTED INORGANIC CONTAMINANTS IN DRINKING WATER VII TOXICITY OF SELECTED ORGANIC CONTAMINANTS IN DRINKING WATER IX 1 9 18 108 137 152 202

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DRINKING WATER AND HEALTH

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