Erethism

Mercury poisoning, chronic (neurological symptomatology)
Elemental mercury
SpecialtyEmergency medicine Edit this on Wikidata

Erethism,[n 1] also known as erethismus mercurialis, mad hatter disease, or mad hatter syndrome, is a neurological disorder which affects the whole central nervous system, as well as a symptom complex, derived from mercury poisoning. Erethism is characterized by behavioral changes such as irritability, low self-confidence, depression, apathy, shyness[2][3] and timidity, and in some extreme cases with prolonged exposure to mercury vapors, by delirium, personality changes and memory loss. People with erethism often have difficulty with social interactions. Associated physical problems may include a decrease in physical strength, headaches, general pain, and tremors,[4] as well as an irregular heartbeat.

Mercury is an element that is found worldwide in soil, rocks, and water. People who get erethism are often exposed to mercury through their jobs. Some of the higher risk jobs that can lead to occupational exposure of workers to mercury are working in a chlor-alkali, thermometer, glassblowing, or fluorescent light bulb factory, and working in construction, dental clinics, or in gold and silver mines.[5][6][7] In factories, workers are exposed to mercury primarily through the base products and processes involved in making the final end consumer product. In dental clinics it is primarily through their interaction and installation of dental amalgams to treat dental caries.[7] In the case of mining, mercury is used in the process to purify and completely extract the precious metals.[8]

Some elemental and chemical forms of mercury (vapor, methylmercury, inorganic mercury) are more toxic than other forms. The human fetus and medically compromised people (for example, patients with lung or kidney problems) are the most susceptible to the toxic effects of mercury.[9]

Mercury poisoning can also occur outside of occupational exposures including in the home. Inhalation of mercury vapor may stem from cultural and religious rituals where mercury is sprinkled on the floor of a home or car, burned in a candle, or mixed with perfume. Due to widespread use and popular concern, the risk of toxicity from dental amalgam has been exhaustively investigated. It has conclusively been shown to be safe[10] although in 2020 the FDA issued new guidance for at-risk populations who should avoid mercury amalgam.[11]

Historically, this was common among old England felt-hatmakers who had long-term exposure to vapors from the mercury they used to stabilize the wool in a process called felting, where hair was cut from a pelt of an animal such as a rabbit. The industrial workers were exposed to the mercury vapors, giving rise to the expression "mad as a hatter".[12] Some believe that the character the Mad Hatter in Lewis Carroll's Alice in Wonderland is an example of someone with erethism, but the origin of this account is unclear. The character was almost certainly based on Theophilus Carter, an eccentric furniture dealer who was well known to Carroll.[13]

  1. ^ ἐρεθισμός. Liddell, Henry George; Scott, Robert; A Greek–English Lexicon at the Perseus Project.
  2. ^ WHO (1976) Environmental Health Criteria 1: Mercury, Geneva, World Health Organization, 131 pp.
  3. ^ WHO. Inorganic mercury. Environmental Health Criteria 118. World Health Organization, Geneva, 1991.
  4. ^ Faria, Marcília de Araújo Medrado (February 2003). "Mercuralismo metálico crônico ocupacional" [Chronic occupational metallic mercurialism]. Revista de Saúde Pública (in Portuguese). 37 (1): 116–127. doi:10.1590/s0034-89102003000100017. PMID 12488928.
  5. ^ Nagpal, Natasha; Bettiol, Silvana S.; Isham, Amy; Hoang, Ha; Crocombe, Leonard A. (March 2017). "A Review of Mercury Exposure and Health of Dental Personnel". Safety and Health at Work. 8 (1): 1–10. doi:10.1016/J.SHAW.2016.05.007. PMC 5355537. PMID 28344835.
  6. ^ Poulin, Jessie; Gibb, Herman (2008). Prüss-Üstün, Annette (ed.). Mercury: Assessing the environmental burden of disease at national and local levels. World Health Organization. hdl:10665/43875. ISBN 978-92-4-159657-2.[page needed]
  7. ^ a b Neghab, Masoud; Amin Norouzi, Mohamad; Choobineh, Alireza; Reza Kardaniyan, Mohamad; Hassan Zadeh, Jafar (January 2012). "Health Effects Associated With Long-Term Occupational Exposure of Employees of a Chlor-Alkali Plant to Mercury". International Journal of Occupational Safety and Ergonomics. 18 (1): 97–106. doi:10.1080/10803548.2012.11076920. PMID 22429533. S2CID 857837.
  8. ^ Satoh, Hiroshi (2000). "Occupational and Environmental Toxicology of Mercury and Its Compounds". Industrial Health. 38 (2): 153–164. doi:10.2486/INDHEALTH.38.153. PMID 10812838.
  9. ^ Medicine Health. "Mercury poisoning." Emedicine Health. N.p., 23 Apr. 2010. Web. 23 Apr. 2012. <http://www.emedicinehealth.com/mercury_poisoning/article_em.htm>.
  10. ^ FDA. "Appendix I : Summary of Changes to the Classification of Dental Amalgam and Mercury". Food and Drug Administration. Retrieved 26 August 2018. FDA has concluded that exposures to mercury vapor from dental amalgam do not put individuals age six and older at risk for mercury-associated adverse health effects. ... FDA estimates that the estimated daily dose of mercury in children under age six with dental amalgams is lower than the estimated daily adult dose. ... FDA has concluded that the existing data support a finding that infants are not at risk for adverse health effects from the breast milk of women exposed to mercury vapors from dental amalgam.
  11. ^ Health, Center for Devices and Radiological (18 February 2021). "Dental Amalgam Fillings". FDA. Retrieved 16 November 2021.
  12. ^ Tchounwou, P. B.; W. K. Ayensu; N. Ninashvili; D. Sutton (6 May 2003). "Environmental exposure to mercury and its toxicopathologic implications for public health". Environmental Toxicology. 18 (3): 149–175. doi:10.1002/tox.10116. PMID 12740802. S2CID 84386939.
  13. ^ Waldron HA (1983). "Did the Mad Hatter have mercury poisoning?". British Medical Journal. 287 (6409): 1961. doi:10.1136/bmj.287.6409.1961. PMC 1550196. PMID 6418283.


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