INTRODUCTION Minamata Disease is one of the worst disasters in modern history.

About forty-five years since its discovery in May 1956, it is yet to be resolved. This short chronology examines the policies and measures taken by the Japanese national and Kumamoto prefectural governments as they relate to Minamata Disease. In the days when Minamata disease was first discovered, since a cause had not been found, it was locally called the 'strange disease', and was thought to be infectious. In the beginning, it was reported as the 'Minamata strange disease' by the mass media. As 'strange disease' was not an acceptable medical term, the Kumamoto University Study Group tentatively named the disease after the area from which it originated in 1957. Thus the name 'Minamata disease' was born. By August 1958, about one and a half years since the first case was reported, almost all newspapers were calling it Minamata disease. For the Japanese national government and Kumamoto prefecture the political

powers concerning this disaster policies and countermeasures for Minamata Disease were not about comprehensive relief for victims. Rather, the forty-five year history of Minamata Disease has shown it to be completely the reverse. In one word, throughout the history of Minamata Disease, both the national and Kumamoto prefectural governments consistently stood on the side of the polluter which had caused the disaster. As a result of initial efforts by the national and prefectural governments when the outbreak occurred, Minamata Disease was declared "concluded" in 1960. Now again in 2001, this time in front of the entire international community, efforts are being undertaken to bring down the curtain on the Minamata Disease disaster forever. This is being done despite the fact the extent of the disaster and the resulting numbers of victims are unknown, and medical science concerning Minamata Disease as well as the responsible parties in the disaster being left ambiguous. Niigata Minamata Disease is an organic mercury intoxication prevailed in the Agano River area in central part of Niigata Prefecture in 1950s and 1960s. Many patients have suffered from the disease until today, and some of them died of it in extreme agony. This disease was caused by methyl mercury from Kanose technology. 1 Factory of Showa Denko which produced acetaldehyde as its main product in terms of limestone based chemical

Methyl mercury is a form of mercury that tends to be more readily accumulated in the tissues and more slowly excreted by the body than other forms of mercury thus making it more significant in bioaccumulation. Discharged methyl mercury was stored and condensed in plankton, aquatic insects and fish of the river and was eaten by many people and made Niigata Minamata Disease patients. Some of them presented a case to Niigata District Court in 1967 and won the case in 1971. HISTORY OF MINAMATA DISEASE

Figure 1 : The Map of Minamata Bay and Agano River Minamata is a small town facing the Yatsushiro Sea, also called Shiranui Sea, in Kumamoto Prefecture on Kyushu Island in southern Japan and abundant in fishing resources. On a spring day in 1956, a girl of five years old in the town was found to have unusual neurological symptoms. She had convulsions and difficulties in walking and speaking. She was the first well documented case of Minamata disease, and was officially reported with other three cases including her sister on May 1, 1956.

First Minamata Disease (Mercury Poisoning)

Minamata disease is a methyl mercury poisoning associated with the daily consumption of large quantities of fish and shellfish heavily contaminated with the toxic chemical. The disease shows a variety of clinical symptoms depending on the exposure level to the chemical. The company responsible for the Minamata epidemic was the chemical company Chisso. Chisso was a prominent company with advanced technologies in Japan at the time. In the Minamata disease episode, methyl mercury was generated as a by product in reaction chambers for manufacturing acetaldehyde that was synthesized by a hydrolysis of acetylene using mercury as a catalyst. Methyl mercury, after discharging into the sea, accumulated in fish and shellfish by the absorption through the gills or digestive tracts.

Figure 2 :The Route Of Methyl Mercury From Generation In Acetaldehyde Process To Human Body Following the official identification of the first patient in 1956, research teams were organized in Kumamoto University School of Medicine and later in the Ministry of Health and Welfare (MHW). The University research group identified the causative agent within the first three years. However, the epidemiological findings were not effectively exploited to prevent the spread of the disease. The factory waste was suspected as the source of the causative agent but it seemed difficult to prove it. Since the ingestion of marine products caught in Minamata Bay 3

apparently caused the disease, the Kumamoto Prefecture government recommended not eating fish and shellfish of the bay in 1957, but did not actually prohibit the fishing or eating of them. As new patients continued to be found during the summer of 1958, the Minamata fishermens cooperative claimed compensation for damages of fishing operation in the hazardous sea area and demanded immediate elucidation of the cause of the disease. Chisso changed the acetaldehyde drainage channel from the waste outfall of Minamata Bay, where water tends to stay, to the mouth of Minamata River in September 1958. The research group of Kumamoto University presented, in July 1959, the organic mercury hypothesis for the etiology of Minamata disease based on pathological and clinical findings and on the fact that mercury was detected at extremely high concentrations in the sludge of Minamata Bay with a maximum of 2,000 ppm at the waste outfall. Chisso also made an agreement in December 1959 with the patients association consisting of 78 patients and some of their families to pay an annuity of 100,000 yen as consolation money to each of adult patients. In November 1959, the Committee presented its official conclusion, based on the report of the sub-committee, that Minamata disease was a kind of organic mercury poisoning induced by the intake of polluted fish and shellfish caught in Minamata Bay. Second Minamata Disease (Mercury Poisoning) In the history of public health, diseases can sometimes be eradicated before their causes are properly understood. However, this was not the case with Minamata disease. While the causative agent of Minamata disease had not been officially accepted in spite of the research achievements and no comprehensive measure was taken to prevent the pollution from enlarging, another tragedy happened when patients of methyl mercury poisoning were found along the basin of the Agano River in Niigata Prefecture in January 1965.

Figure 3 : The Route Of Methyl Mercury From Generation In Acetaldehyde Process To Human Body (by Kanose Factory) The experience in Minamata was enough for the government to take prompt measures including a medical examination involving a hair mercury survey of the inhabitants of the lower basin of the Agano River. Contraception was recommended for women who had hair mercury levels of 50 ppm or higher to prevent fetal cases. Showa Denkos Kanose factory located on the upper Agano River, which had been synthesizing acetaldehyde until January 1965, was suspected as the most plausible source of methyl mercury in the basin. By the mid 1960s in Japan, air and water pollution, known as kogai (public hazard), had become a serious problem as the negative consequences of the rapid growth of the heavy and chemical industries. The Basic Law for Environmental Pollution Control was established in 1967. Twelve years had already passed since the first recognition of the patient in 1956. MEASURE TO CONTROL ENVIRONMENTAL POLLUTION From 1932, effluent containing methyl mercury, created in the acetaldehyde manufacturing process of Chisso Minamata factory, was discharged into Minamata Bay (once also into the mouth of Minamata River). Whilst imperfect, the refined drain recycling system, thought to be partially effective in extracting mercury, was adopted in August 1960. In June 1966, due to the realization of a complete effluent processing system, effluent containing methyl mercury in principle, ceased 5

to be discharged, and in May 1968, the pollution source disappeared due to the discontinuation of acetaldehyde production. In February 1969, The Economic Planning Agency designated the Minamata ocean expanse as an appointed water expanse under the (now former) Water Quality Control Law, also establishing a standard on water quality, and initiating regulation of methyl mercury under the (former) Factory Eff1uent Control Law. In December 1970, the Water Po11ution Control Law was enacted, followed by nationwide uniform regulation of the discharge of toxic substances such as mercury.

MEASURE TAKEN REGARDING THE CONTAMINATION OF FISH AND SHELLFISH Instruction to Fishermen to Voluntarily Refrain from Catching and Consuming Fish - The Self-Imposed Fishing Bans From around the end of 1956, during the pursuit of the cause of Minamata disease, initial recognition that the extraction of large quantities of fish and shellfish from Minamata Bay was inducing the disease, set in. For this reason, Kumamoto Prefecture implemented voluntary restrictions on fishing and consumption of fish and shellfish, and later began consideration of the implementation of the Food Sanitation Act. On July 24, 1957, the Committee on Measures Against the Minamata Unknown Disease, decided to announce its plan under Article 4 of the Food Sanitation Act, to prohibit the capturing of fish and shellfish for retail purposes from Minamata Bay. (This committee consisted of the Chairman = Vice Governor, a vice-chief and relevant section chiefs from the Departments of Health, Public Welfare, Engineering & Construction, and Economics). On August 16, the Committee made inquiries to the Ministry of Health and Welfare on the possible implementation of the Food Sanitation Act regarding fish and shellfish taken from Minamata Bay. On September 11, the Ministry of Health and Welfare replied, "As there is no clear evidence that all fish and shellfish of a specific area of Minamata Bay are contaminated, the Food Sanitation Act is not applicable to fish and shellfish caught in Minamata Bay". Thus, Kumamoto Prefecture was unable to implement the Food Sanitation Act, resulting in continued enforcement of voluntary restrictions on consumption of fish and shellfish from Minamata Bay. Administrative guidance beseeching the Minamata Fisheries 6

Cooperative Association (hereafter called the Minamata Fisheries Co-op) to exercise selfregulation of fishing in the bay was also subsequently enforced. Even after the Ministry of Health and Welfare refused to implement the Food Sanitation Act, Kumamoto refecture and Minamata City continued to petition to related ministries, demanding special legislation prohibiting fishing and designating danger water areas, however, no legislation to this effect was passed. In the period 1955-1964, black porgy containing 24ppm of mercury, and barracuda containing 58ppm of mercury had been confirmed in the Minamata Bay and surrounding areas. The Minamata Fisheries Co-op placed self-imposed restrictions on harvests from Minamata Bay from August 1957. From July 1960, together with the cooperation of the town, the Co-op was able to provide guidance to ensure harvesting did not take place by expanding the regulated area to within 1000 meters of land, and through activities such as patrolling the area with a patrol boat. Due to the Minamata Fisheries Co-op's self-imposed restrictions on fishing, as well as the Chisso Minamata factory setting up a sedimentary pool and effluent processing device after 1960, it was believed that the phenomenon of patients falling ill to Minamata disease had come to a halt in this same year. It was under these circumstances that the Minamata Fisheries Co-op, in April 1962, lifted the voluntary restrictions on fishing, with the exception of restrictions in Minamata Bay. Subsequently, in May 1964, the Co-op completely abolished all restrictions on harvesting in the bay. On May 22, 1973, when the Kumamoto University Second Minamata Disease Medical Study Group announced "the fish and shellfish of Minamata Bay and surrounding areas are still unsafe. If consumed in large quantities, there is a danger that there will be an outbreak of the disease", the Minamata Fisheries Co-op, with the guidance of Kumamoto Prefectures, once again enforced voluntary restrictions, by establishing restricted fishing areas, and organizing patrol boats.

National Government establishes "Provisional Regulatory Standards for the Level of Mercury in Fish and Shellfish" 7

On July 23 1973, given the social situation, to dissolve consumers' anxieties regarding mercury contamination, the government enacted the "Provisional Regulatory Standards for the Level of Mercury in Fish and Shellfish", requiring total mercury to be less than 0.4ppm, and methyl mercury to be less than 0.3ppm. Installation of Dividing Nets by Kumamoto Prefecture In an effort to calm social panic and stabilize plummeting fish prices, Kumamoto Prefecture began construction in January 1974, of dividing nets, which would close off the mouth of Minamata Bay and prevent the spread of contaminated fish. The nets closed off the bay for a period of 23 years until their complete removal on October 14, 1997. Prohibition of (Fishery) Operations while Pollution Prevention Project works underway Having established the 'Agreement on Compensation for the Fishing Industry' with Kumamoto Prefecture, from April 1, 1975 to March 31, 1990, during the implementation of pollution prevention operations, the Minamata Fisheries Coop, prohibited fishing in Minamata Bay. Removal of the Dividing Nets Due to consistent decline in the mercury levels in the fish and shellfish of the bay, the Kumamoto Prefecture Special Committee on Fish and Shellfish in Minamata Bay met in August 1993, and with the recommendation of the Minamata Fisheries Co-op, proposed a gradual phasing out of the dividing nets. In October the prefecture installed inner dividing nets separating Minamata bay and Nanatsuse zones. In an investigation in the latter part of fiscal 1994, it was confirmed for the first time that the mercury levels of all fish and shellfish inhabiting both zones were below the provisional regulatory levels. In February 1995, the Committee concluded that the complete removal of the nets was still premature and instead proposed the removal of only a part of the nets (the outer dividing nets of the Nanatsuse sea area). In April, Kumamoto Prefecture began work on the dismantling of the dividing nets on the outer side of the Nanatsuse zone. Dismantling of the nets was completed in June, and the Nanatsuse sea area was opened. "Minamata Bay Declared Safe" -Removal of the Minamata Bay Dividing Nets In February 1997, Kumamoto Prefecture drew up its "Basic Policy on Measures for Fish and She1lfish of Minamata Bay" which included provisions for removing the Minamata 8

Bay dividing nets in 1997 if confirmation could be made, after an investigation to be conducted in the first half of the 1997 fiscal year that mercury levels were below regulatory levels and had been so for three years. This report was given to the meeting of the Committee on Fish and Shellfish. Having given its unanimous approval of the policy, the committee was then dissolved. In accordance with its policy, Kumamoto Prefecture initiated a follow up investigation in the first half of fiscal 1997, confirming the continuing decline of mercury levels in all fish species, and that the mercury levels had remained below provisional regulatory standards for the past three years. This report was then sent to former members of the Committee on Fish and Shellfish, for verification. Meanwhile, meetings were held for interested local parties and a11 coastal fishing associations, in an attempt to obtain the public`s understanding and acceptance of evidence that the bay fish and shellfish were safe. The meetings proceeded without a single dissenting opinion from those in the fishing industry, other related residents of the prefecture or the citizens of Minamata City. Stressing the fact that confirmation had been made regarding the safety of the marine products of Minamata Bay, and that a consensus had been reached by the citizens of the prefecture, Kumamoto Prefecture Governor Fukushima issued the "Minamata Bay Safety Declaration" on July 29, 1997. The declaration announced the decision to completely remove the last of the dividing nets, which had been set in place in January 1974, 23 years before. Removal operations began on August 21, and on the 23rd of the same month, the net section was removed. The entire operation of removing the anchors, sounding equipment and supplemental facilities was completed on October 14. On the afternoon of the following day, October 15, Minamata Bay was re-opened as a general fishing zone, and the Minamata Fisheries Co-op re-commenced harvesting for the fish market after a period of 24 years. After the removal of the dividing nets, erring on the side of caution, it was decided that investigations into the level of mercury in fish species in Minamata Bay, should be carried out twice a year for a period of three years, until 2000.

SYMPTOMS OF MINAMATA DISEASE Minamata Disease is a poisoning disease that nervous system, mainly central nervous system, is damaged by methyl mercury. It is established that the disease differs from inorganic mercury poisoning which damages kidneys. The main signs and symptoms 9

are sensory disturbance in the distal portions of four extremities, cerebellar ataxia, bilateral concentric contraction of the visual field, disturbed ocular movement caused by central nervous system (CNS), impairment of hearing caused by CNS, and equilibrium disturbance caused by CNS. Other than that, the children were born with severe deformities, including gnarled limbs, mental retardation, deafness, and blindness. Also numbness in the limbs , difficulty in moving the hands and legs, narrowed visual field, language disorder, hand and leg tremors, and movement disorder of the eyeball.

Figure 4 : Gradational Relation between the amount of Methyl Mercury and Symptoms

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Figure 5: Examples of symptom of Minamata Disease

Figure 6 : Examples of Symptoms Minamata Disease (Numbness of the limb and difficulty in moving the hands)

Figure 7 : Examples of Symptoms Minamata Disease on a cat (Test by let the cat to drink the water from wastewater contains Methyl Mercury)

MINAMATA DISEASE TREATMENT AND THERAPY Presently, there is no cure for congenital Minamata disease. Prevention of the mother from ingesting mercury while pregnant is the only way to prevent the disease. Once the disease is present only therapies to ease the symptoms may be used. Some therapies that may be used are:

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Physical Rehabilitation: there are varying degrees of paralysis and muscle function loss by those affected by Minamata Disease and physical therapy can help patients learn to control their bodies and physical functions more effectively. (Tan, 2010)

Drug therapy: anticonvulsant drugs can be used for those that suffer convulsions. (Tan, 2010)

Chelating agents: these are agents that competitively bind with heavy metals and react with them in such a way that they can't bind to the tissues in the body and cause further harm. Some examples of chelating agents specifically used for mercury poisoning are succimer, dimercaprol and dimercaptosuccinic acid. Succimer, a metal chelator is the best.

CONCLUSION The history of Minamata disease may be regarded as that of the following tragedy, no responsible decision has been made by the Government; any necessary measure to counter the disease has not been considered for a long period consequently, and serious casualties effect were given to the inhabitants. With regard to the problems about pollution with chemical substances, there are two stand points of the safety; i.e., from one standpoint, chemical substances, safety of which is not or will not be confirmed not only at present but also in the future, should not be discharged into environments, and from the other standpoint, a certain chemical substance may be discharged before the chemical substance is confirmed to be harmful. Considering from viewpoints of preliminary prevention of environmental pollution and prevention of the spread, everybody should agree with the former principles of the priority of safety. However, when concrete measures to counter environmental pollution with chemical substances are considered, various objections against the measures are raised, as follows: Any causative chemical substance has not been identified; with regard to the chemical substances, harmfulness of which has not been demonstrated, regulation of the chemical substances may damage considerably industrial activities. Thus, decision of important policy or social countermeasure is not necessarily made rapidly because of such dissenting voices. Considering the seriousness at the time point when the current pollution with chemical substances, the spread of the pollution, and the casualties were confirmed, it 12

should be beyond medical aid to consider countermeasures after the scientific elucidation of harmfulness and the mechanisms. There are many things that can be learned from the failed experience of Minamata disease; e.g., the way how to rapidly decide the opinion as the Government under the state in which insecurity remains.

REFERENCE 1. Noriyuki Hachiya, 2006. The History and The Present of Minamata Disease. 2. Ministry of the Environmental, Japan. Lessons from Minamata Disease and Mercury Management in Japan. 3. Minamata Disease Municipal Museum, 2007. Minamata Disease Its History and Lessons. 4. Yoko Tsurumi. Minamatas Moyainaoshi Movement and Sustainable Development : Recovery from Division. 5. Kazumasa Takemori, 2012. Niigata Minamata Disease and Showa Denko. URLs 1. http://www.nimd.go.jp/syakai/webversion/pdfversion/e024038_chap2.pdf 2. http://www.mkplan.org/images/kisogakushuen.pdf 3. http://www.env.go.jp/en/chemi/hs/minamata2002/ch3.html 4. http://minamatadisease.weebly.com/treatment-and-therapies.html 5. http://www.nimd.go.jp/archives/english/tenji/a_corner/a01.html 6. http://www.sundaytimes.lk/070930/International/international000016.html

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