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Objective: The purpose of this study was to evaluate the presence of exposure to inorganic mercury and its health effects among people living near a sewage sludge dumping site in Nagasaki Prefecture, Japan. In this area, sewage sludge and industrial waste have been dumped since 1975, and total mercury levels exceeding the water quality standards (0.0006-0.0020 mg/l) have been detected in seeping water and river water since July 1997., Methods: The population for the present study comprised 48 subjects (aged 11-91 years) living near a sewage sludge dumping site and 49 subjects (aged 10-82 years) living in a non-polluted area. In November and December 1998, subjective symptoms of inorganic mercury exposure, history of occupational exposure to inorganic mercury, frequency of fish intake, sources of drinking water and other health habits were inquired by a self-administered questionnaire. Total mercury and total protein levels and N-acetyl-beta-D-glucosaminidase (NAG) activity in morning urine specimens were also measured., Results: Among males, the proportion of subjects who complained of tremor in the hands (P = 0.02) and increased irritability (P = 0.10) was higher in the polluted area than in the control area. In addition, the proportion of those who did not report being easily fatigued was lower in the polluted area than in the control area (P = 0.07). Among females there was no significant difference in the prevalence of self-reported symptoms related to the central nervous system disturbance between the two areas. After adjustment for gender and age using logistic regression analysis, the prevalence of increased irritability was significantly higher (P = 0.05) and the proportion of those who did not report being easily fatigued was significantly lower (P = 0.03) in the polluted area than in the control area. However, there was no significant difference in the geometric mean of urinary total mercury concentration (microgram/g creatinine) between the polluted area (0.66, 95% confidence interval [CI] 0.48-0.91 for men and 0.96, 95% CI 0.70-1.33 for women) and the control area (0.81, 95% CI 0.60-1.09 for men and 0.83, 95% CI 0.57-1.22 for women). There was no individual whose total mercury concentration in urine exceeded 30 micrograms/g creatinine, at which level of urinary total mercury toxic effects on the central nervous system have been reported in industrial workers. There was also no significant difference in the geometric means of urinary total protein level and NAG activity., Conclusion: There was no evidence of excessive exposure to inorganic mercury among residents in the polluted area. Thus, we concluded that the difference in the prevalence of subjective symptoms was not due to the direct effect of exposure to inorganic mercury. To prevent the contamination of water by taking measures against pollution sources, monitoring of the quality of drinking water, and finally to secure safe water supply by public waterworks are required.

A 59-year-old man showed slowly progressive intentional tremor for 40 years prior to first visit to us in 1996. He was exposed to mercury vapor for about 3 years (1956-1959) and the diagnosis of chronic inorganic mercury poisoning was made. Hasegawa dementia scale-revised (HDS-R), mini-mental state (MMS) examination and P300 examination were performed. HDS-R and MMS were within normal range but the latency of P300 was remarkably prolonged. His tremor was considered to be due to chronic inorganic poisoning because there were no other causes and the frequency of his tremor was 3-4 Hz. which was lower than that in essential tremor. The prolonged P300 latency was also considered to be due to the same cause because there were no other causes and the head MRI were normal. Chronic inorganic mercury poisoning has been reported to produce organic changes in the brain and P300 is considered to be useful to detect these changes.

In both Minamata disease (MD) and HTLV-I associated myelopathy (HAM), sensory disturbance is one of the most characteristic clinical symptoms. We have examined median nerve SSEPs (MN-SEP) and posterior tibial nerve SEPs (PTN-SEP) of both patient groups, and reported their specific abnormalities. MN-SEP of MD patients never showed any conduction delay nor conduction block at the cervical cord. However, they demonstrated the initial positive cortical response with low amplitude instead of the initial negative response (N20) seen in healthy subjects. In PTN-SEP, MD patients showed the initial positive cortical response with significantly shorter latency and lower amplitude than healthy subjects. These findings have never been seen in any other diseases. On the other hand, the conduction delay and conduction block on peripheral nerve, spinal cord and/or intracranial sensory tracts have been demonstrated in many cases with HAM. The patient was a 60-year-old man. About 40 years ago, he suffered with typical clinical symptoms of MD such as cerebellar ataxia, intention tremor and sensory disturbance of upper and lower extremities, and then his condition was complicated with progressive spastic paraplegia and urinary bladder dysfunction since 30 years ago. Both MN-SEP and PTN-SEP were studied so that we could make the electrophysiological differential diagnosis of MD and HAM. His MN-SEP indicated both the conduction delay at his cervical cord and intracranial sensory tract and the initial positive potential from cephalic recording. Furthermore, his PTN-SEP demonstrated severe conduction block at the spinal cord and neither cervical response (N28) nor cortical response (P37) was evoked. In conclusion, the clinical electrophysiologic studies supported our notion that the case might be affected with both MD and HAM.

A male, born on December 8, 1956, during the period when many Minamata diseases broke out in a district. His parents who ate much fish and shell fish taken in Minamata Bay suffered from the light, incomplete Minamata disease showing sensory disturbance, the constriction of the visual field, muscular weakness, etc. He weighed 3,225 gr. upon the normal birth given 10 months after pregnancy. His abnormalities were noted since his head was not stabilized on the neck even six months after the birth. Because of the delay in the development of the motor function, he became barely able to sit, stand up and begin walking at the ages of 3, 5 and 6 respectively. In 1962 (at the age of 6), his congenital Minamata disease was diagnosed in view of his clinical symptoms and epidemiological conditions. The mercury value in the hair and blood upon the birth is not known because a considerable time had elapsed after the birth when his mercury poisoning was discovered. However, the clinical symptoms included intelligence disturbance, character change, dysarthria, primitive reflexes, strabismus, hypersalivation, ataxia and hyperkinesia, indicating a typical congenital Minamata disease. Until he became 13 years old (1969) or so, his mental and motor function developed, both gradually. In the same year, he was admitted to a special class for the handicapped. EEG examination revealed that there was a slow alpha activity in the basic pattern and that 6 Hz positive spike was found in the sleep EEG. The constriction of the visual field was classified through examination.2+

The present study was designed to determine critical brain mercury concentrations associated with specific behavioral changes during exposure to mercury vapor. Rats exposed to 3 mg of Hg/m3 for 3 hours, 5 days per week, for 15-42 weeks, showed a decline in conditioned avoidance response. The latency of escape response also increased in pole climb shock escape. The time to the onset of effects varied from 12 to 39 weeks among 14 rats exposed to mercury. All rats recovered to preexposure baseline within 12 weeks after the termination of exposure. A significantly poor behavioral performance was noticed in rats with brain mercury concentration of approximately 20 microgram Hg/g. Behavioral recovery was seen when the mercury concentrations decreased to 10 microgram Hg/g brain tissue. These results suggest that the critical concentration of inorganic mercury in the brain associated with behavioral changes in the rat ranges about 10 ppm to 20 ppm. In spite of the high concentration of mercury, the nervous tissues of rats in this experiment with mercury vapor intoxication were normal.