Minamata Disease and The Photography of W Eugene

Minamata Disease and The Photography of W Eugene Smith Martin Donohoe http: //www. publichealthandsocialjustice. org

Outline • Introduction • Mercury and Methylmercury as pollutants • Minamata Disease • W Eugene Smith – bio and photos • Minamata Convention

Mercury • Mercury ore (cinnabar) used as pigment since Neolithic era (found in 10, 000 yr old cave paintings) • Ancient Romans, Chinese used as rouge makeup • Pigment mixed with wax for document seals in Middle Ages

Mercury • Syphilis Treatment - 15 th Century onward - abandoned 1940 for penicillin • Recognized as cause of disease in 19 th Century (Hunter-Russell Syndrome) - chemists, hatters (matted fur together with mercuric nitrate to make felt hats)

Mercury • Used in late-19 th Century to extract silver from pulverized ore • Diuretic (used through mid-20 th Century) • Used as a preservative in latex paints until banned by EPA in 1991

Mercury • Added by US government to industrial alcohol during Prohibition to make it more lethal and discourage moonshine production (1926 -1933) – Led to more than 10, 000 deaths

Mercury • Used in chlor-alkali plants to make chlorine and sodium hydroxide for industry • Used in production of vinyl chloride, an important ingredient in plastics and vinyl

Mercury • Hg miners at high risk • Found today in Chinese medications, skin lightening creams, hair dyes

Mercury • Half from volcanic eruptions and other geological processes • Released into air by coal combustion, industrial processes, mining, and waste disposal – 4500 tons/yr

Mercury • Travels throughout atmosphere and settles in oceans and waterways • Bacteria convert it to toxic methyl-mercury • Levels in Great Lakes, Great Salt Lake rising

Mercury • Travels up food chain via fish – Warmer temperatures increase metabolic rate and ability of fish to accumulate – Avoid top predators (tuna, shark, swordfish • Acadian redfish, aka dogfish – used in school lunch programs – 1/3 of US exposure to methylmercury from canned tuna

Gold Mining Gold = Cyanide + Mercury • Mercury used to capture gold particles as an amalgam • Gold leached from ore using cyanide – Cyanide paralyzes cellular respiration • At least 18 tons of mine waste created to obtain the gold for a single 3 oz. , 18 k ring

Gold Mining and Mercury • Contaminated groundwater often sits in large toxic lakes held in place by tenuous dams • Release of cyanide and mercury into local waterways kills fish, harms fish-eating animals, and poisons drinking water

Mercury • Other sources: – Deforestation and runoff – Industrial boilers – Tooth fillings – Car batteries – Cosmetics

Mercury • Contaminant in high fructose corn syrup • Gluten-free diets may contain more mercury (and arsenic) due to higher intake of rice-/rice syrup-based products (rice absorbs metals from water and soil)

Mercury • Dental amalgams: – 50% mercury; 50% silver, copper, tin, zinc mixture – dental amalgam factory workers at high risk – Mercury dental amalgams pose health risks to pregnant women, unborn babies, and children (FDA Black Box Warning added 2009) – esp tooth grinders

Mercury • Dental amalgams: – No link with nervous system toxicity and no benefit to removal in adults – However, human cremations (increasing) releases 2 -4 g Hg/body if amalgams present

Mercury • 720, 000 metric tons removed from ground since 1850 • 57% of mercury released since 1850 circulates in environment • 43% locked away in sediments and landfills

Mercury • Long biological half-life - 1 -3 years in humans • Mercury costs U. S. economy $5 billion/yr • Regulation inadequate – Allows “cap and trade”

Mercury • 16% of women of childbearing age exceed the EPA’s “safe” mercury level • 75, 000 newborns/yr in US have increased risk of learning disabilities associated with mercury exposure in the womb • Freshwater fish mercury levels too high for pregnant women to eat in 43 states • Consumers Union disagrees with FDA recommended limits on tuna consumption for pregnant women – States pregnant women should not eat ANY tuna

Minamata Bay • • Southern Japan Shiranui Sea Fishing village Villagers: fisherman/Chisso Corporation employees and their families

Chisso Corporation • Established 1918 • Produced acetaldehyde for plastics, drugs, perfumes, photography • Mercury (Hg) catalyst • Byproduct = methylmercury, dumped into bay (150 tons over 4 decades) • Dumped over 60 deadly poisons, including vinyl chloride (cause of liver cancer)

Chronology of Chisso's Environmental Pollution • 1925 - local fishing cooperative compensated for decreased catch • 1950 s - bizarre behavioral changes observed in birds, marine fish, land vertebrates; oysters vanish • 1950 s / 1960 s - reports in Japanese medical journals about human cases

Chronology of Chisso's Environmental Pollution • 1956 - cause (Me. Hg) of Minamata Disease elucidated • 1958 -60 - reports in English medical journals • 1959 -69 - Dr. Hosokawa's experiments – Cat #400 – Other studies • 1959 cyclator added – Removed Hg, but not Me. Hg

Chronology of Chisso's Environmental Pollution • 1965 - fishing banned in Minamata Bay after similar events noted in Niigata, Japan • 1968 - all acetaldehyde-producing plants ceased operating • 1970 - Japan Water Pollution Control Act – Allowed no detectable Hg or Me. Hg in waste water

Chronology of Chisso's Environmental Pollution • 1997 – Minamata Bay declared free of mercury • 2004 – Japanese Supreme Court rules government shares responsibility for epidemic (government slow to react, cut off research funding in 1962)

Minamata Disease • 3, 000 official cases in Minamata Bay (almost 2, 500 dead) – Tens of thousands of unofficial cases – Number of victims may be as high as 100, 000 • Social stigma / Poor health care

Congenital Minamata Disease: Signs and Symptoms • Congenital: high dose → infertility; medium dose → spontaneous abortions; low dose → congenital disease (including anencephaly and spina bifida) • S/S: poor physical growth, mental retardation, impaired speech/chewing/swallowing, muscle tone abnormalities, involuntary movements, constricted visual fields - EDTA not effective

Signs and Symptoms • Acute / Chronic Poisoning: – Numbness, slurred speech, ataxia, unsteady gait, deafness, poor vision, dysphagia, hypersalivation, confusion, drowsiness/stupor to irritability/restlessness – Linked to autism – Chronic liver disease, liver cancer – Nephropathy

Signs and Symptoms • Acute / Chronic Poisoning: – Hypertension – Autoimmune disorders – Rash - Acrodynia (“pink disease”, small children, swelling and irritation of palms and feet → desquamation, irritability, photophobia, fever, insomnia, profuse sweating – Death within a few months if severe

Diagnosis • Mercury levels in air, blood, urine: – “Normal” level = 5 mcg/l – 20 mcg/l – 100 mcg/l = subacute toxicity, consider treatment – >100 mcg/l in blood and/or urine = toxic, treat

Treatment • Chelation with BAL, penicillamine, DMPS, DMSA (best) – May help with neurologic symptoms – Nephrotic syndrome resolves over several months – Follow levels to assess adequacy of treatment, need for additional doses – Consult occupational medicine/poison control

Civil suit vs. Chisso (1969 -73) • Plaintiffs initially awarded $66, 000 for deceased victims, $59, 000 - $66, 000 for survivors • Precedent - Niigata suit versus Showa Denko – $3. 4 million paid out the first night, $80 million paid out by 1975 • As of 2014, most victims have received financial compensation ($160, 000 - $180, 000; $26000 for those with lesser disabilities)

Civil suit vs. Chisso (1969 -73) • Dr. Hosokawa key witness (from deathbed) – Identity - company employee vs. impartial physician with obligation to patients – Loyalty - company vs. to public

Reasons for Delayed Recognition and Action • Science slow, unfunded/underfunded, corrupt • Dissemination of knowledge slow • Social stigma of disease, fear of contagion • Pressure from fisheries cooperative, Chisso employees

Reasons for Delayed Recognition and Action • Lack of local/world awareness of health effects of pollution • Strong government-business links in Japan, employee loyalty strong

Decreasing Causes and Limiting Consequences of Mercury Pollution • Phase out coal burning power plants • Hospitals phasing out mercury thermometers • Stop buying gold (e. g. , wedding rings) • Make healthy seafood purchases • Screen and treat when appropriate • Avoid tainted cosmetics

Minamata Convention • A set of legally binding measures to curb mercury pollution – As of October, 2017, 128 countries have signed and 6 (including the U. S. ) have ratified – Took effect August, 2017

Minamata Convention • A set of legally binding measures to curb mercury pollution – As of 10/16/14, 128 countries have signed and 6 (including the U. S. ) have ratified – Takes effect 90 days after 50 nations ratify

Minamata Convention • Best emission-control technologies requred for new power plants, boilers and smelters • Compact fluorescent lightbulbs containing over 5 mg Hg banned by 2020 • Primary mercury mining banned (old mines get 15 yrs to close down) • Allows use of mercury in artisanal and small scale gold mining; encourages nations to phase out use altogether

Minamata Convention • Exempts dental fillings, but encourages alternatives • Vaccines with thimerosol (ethylmercury) exempt (very few, trace amounts) • Considered “safe” but best to avoid if possible • But benefits of vaccination great

Minamata Convention • Bans Hg-containing batteries by 2020 (button-cell batteries exempt) • Bans switches and relays with Hg by 2020 • Limits Hg in soaps and some cosmetics

Minamata Convention • Bans Hg in medical devices by 2020 • Exempts religious and traditional uses of Hg • Bans use in certain types of manufacturing • Japan – Asia’s largest exporter of mercury • Japanese industry fighting treaty/trade ban

Minamata Disease Memorial

W Eugene Smith • Born 1918, Wichita, KS • Local news photographer at age 15 • Turned down scholarship to Notre Dame to study photography at NY Institute of Photography • Worked for Newsweek, then Life, then Magnum

W Eugene Smith • • Married to Aileen Smith, photojournalist Minamata: Final Assignment Beaten by Chisso employees Died 1978

Role of the Media in Promoting Awareness of Environmental Health Issues • Books – Henrik Ibsen’s Enemy of the People – Upton Sinclair's The Jungle – Rachel Carson's Silent Spring • Photography – W. Eugene and Aileen Smith's Minamata photoessay – Jacob Riis, Dorothea Lange, Sebastiao Salgado, James Nachtwey, others • Film, TV

Contact Info, References Martin Donohoe martindonohoe@phsj. org This slide show and others available at http: //www. publichealthandsocialjustice. org http: //www. phsj. org