Introduction - Uppsala Monitoring Centre

eported in Australia as early as the 1880s. The report reads: ‘The
disease is observed in girls aged 18 months to three and a half
years. It is characterized by sadness, anxiety, and eventually a
progressive loss of language, with psychiatric symptoms
(hallucinations, coprophagy, delirium during sleep, etc). In addition,
there are sweats and their consequences: viscous, humid skin,
swollen, red and cold hands and feet. The patients feel cold and
permanently irritated. They complain of being itchy, lose their hair
primarily at the temples, but sometimes to the point of complete
baldness. Almost certainly infection of the nail cuticles and
abscesses follow. Internal organs are not affected.’ An association
between mercury and Pink disease (infantile acrodynia) was
suggested by the work of Warkany and Hubbard (1948, 1951),
Fanconi et al (1947) and Fanconi and Botsztejn (1948). In 38 of 41
investigated cases Warkany and Hubbard found an abnormal
quantity of mercury excreted in the urine. Then in 1945 a severely
affected child was admitted to hospital in Cincinnati, Ohio, under the
care of Dr Josef Warkany. The disease was rare in Cincinnati and
Warkany’s interest was aroused. He had a hunch that heavy metal
poisoning might be implicated, so he asked his laboratory to
measure the levels of the common, industrial heavy metals in the
child’s urine. The results were all negative. But one elementmercury-had
not been measured, as there was no adequate test for
it at the time. By luck, Warkany discovered that in Cincinnati there
was a young chemist, Mr Donald Hubbard, who had recently
developed a sensitive method for measuring urinary mercury, so for
the sake of completeness he asked Hubbard to do the measurement
on his patient. The result was strongly positive (Thiele, 2006).
Mercury in the urine doesn’t prove causality, just an association; it
could be due to protopathic bias where early fever due to a virus
infection could be mistaken for teething (fever, flushed cheeks,
peevish, disturbed sleep, lower jaw moved from side to side) hence
the giving of a mercury (calomel) containing teething powder
(Thomson, Steele & Reid, 1896).
In 1947 there was the recognition that mercury in teething and
worming powders caused Pink disease (Black, 1990). However in a
standard textbook on children’s diseases 1954 said ‘Common
disease of unknown aetiology’ giving four theories of causality –
vitamin deficiency, neurotrophic virus infection, chronic mercury
poisoning and salt-deficiency’. By 1953 mercury had been banned
from teething powders in parts of Australia. Since the 1950s the