27.5.2001

"The amalgam question again". 

Anonymous

OHIO STATE J DENT SCI, 2:51-54 (1881).

Though we find little or nothing that is new in Dr. Talbot's
article on this subject, we still consider it timely and appropriate.
That mercury vaporizes at common temperatures is so well
known by men of science that it seems like a waste of time to
prove it, as does Dr. Talbot, yet his experiments are instructive
and profitable; for only a few years ago, prominent and active
members of our profession were claiming that mercury vaporizes
only at 662 degrees and upward, that being its boiling point.  They
might, with equal propriety, set up the claim that water does not
evaporate below 212 degrees; and then it would be hard to account for
the drying of the ground after a shower.

That the vapor of mercury is poisonous is beyond dispute.  No
one can know it much better than the writer, who has been
repeatedly poisoned thus while redeeming mercury from its
oxides -- once till the tongue protruded beyond the teeth for
several days.  It matters not practically whether or not this
vapor must be combined with another element in order to work
its mischief; for the other elements, oxygen, chlorine, sulphur,
etc., are ready to pounce upon it at the earliest opportunity.

But, after all, it is not probable that the vaporization of the
mercury in amalgam fillings in the teeth is the only or even the
chief source of poisoning; for every close observer will recognize
the fact that patients in whose mouths the soluble chlorides
abound, other things being equal, suffer most, while those who
stink with sulphuretted hydrogen suffer least.  The worst cases
of poisoning we have witnessed are those in which the amalgams
retain their original bright color; and in these, whenever tested,
we have found mercuric chloride, or corrosive sublimate.  The
bright surfaces, it is true, are favorable to the vaporization of the
mercury, and the two sources of poisoning acting together are
able to cause the most serious disaster.  This brings to mind
a case which we have had opportunity to watch since 1868.  At
that date the family physician of Mr. H. brought him to our
office for consultation.  He was suffering from profuse ptyalism.
All the salivary glands and his tongue were much swollen.  The
mercurial fetor was sickening, and so intense that it was noticed
on the stairway by parties who followed him to the office.  He
was suffering from TREMOR MERCURIALIS, and complained of a
nearly universal aching of the bones.  His physician diagnosed
mercurial disease;  but his patient persisted that he had never
taken mercury in any form.  He had not been sick before; and
the family physician, till now, had been an eclectic, who
discarded mercury.

As the man owned but six hundred acres of land, and it was
worth only a hundred dollars an acre, and he had nine or ten
teeth to fill, he could not afford gold, and he had amalgam put
in, but not in our office.  The teeth had been filled some weeks
before we saw the case.  We told the physician the composition
of the amalgam plugs, and he at once urged their removal, but
the poor man could not afford it.  The physician abandoned the
case in disgust.  The poor man has endured years of agony, but
has, in the last few years, had most of the amalgam taken out.
He is gradually improving.  A few years ago we treated him to
a mild course of iodide of potassium, which had to be frequently
interrupted on account of a return of ptyalism.  He was a giant
in development and strength; but is now a broken down, prematurely
old man.

Before we had turned our attention toward dental surgery, we
had a case of PARALYSIS AGITANS.  The patient was a young lady
of eighteen years.  She continued to grow worse under our
treatment, till becoming desperate, we began a more thorough
investigation.  Looking carefully into the mouth we found a
mass of blackness.  There was no dentist accessible, so we went
to a gunsmith shop, made two or three excavators, and by a
series of operations, we removed seventeen large and small
amalgam fillings from her mouth.  She recovered rapidly without
other treatment.  She had suffered from ptyalism at an earlier
stage of the case, and before coming under our care.  This
case had baffled the leading physicians of the community,
and we had doubt not it is a type of numerous cases having the
same etiology.  Not that even recognized mercurial poisoning often
manifests the form of tremor; but when we know that amalgam
is used in filling teeth to the extent of tons each year, we should
not be surprised at the great prevalence of nervous diseases.
Physicians should wake up to the importance of this subject; for
it is evident that many obscure diseases, especially of the nervous
and glandular systems, originate from this source.  In the case
of Mr. H. of the six hundred acres, the family physician referred
to, and we are all of many physicians who suspected the influence
of mercury, and yet he got better only in proportion to the
removal of the mercury.  And not only is his own constitution
ruined, but, though he has a healthy wife, his offspring are puny,
neuralgic -- in short, total failures.

Some strange thoughts found utterance in the discussion of
Dr. Talbot's paper.  One thought there could be no danger of
mercurialization from rubbing mercury in the hands, because the
particles are not sufficiently minute to be absorbed till the
metal is vaporized.  But the particles of mercury are as small
when it is liquid as when it is vapor; and, space for space, more
of its particles are in contact with the skin.  And all who read
ought to be familiar with Scheele's case, detailed by Pereira and
others, in which a small quantity of mercury in a leathern bag, left
hanging against the breast produced fatal mercurial poisoning.

It is very fortunate, in view of the fact that so much amalgam
is used, that sulphuretted hydrogen is present in so many
breaths, and cyanide of sulphur in the saliva of so many
patients.  In either case the mercury is sulphidized, and as the
sulphide is less soluble than the oxides or chlorides of the metal,
bad results are less likely to follow.  In a mouth destitute of
the compounds of sulphur, the chloride, (corrosive sublimate)
is more likely to be formed than either of the oxides of
mercury, when amalgam fillings are inserted.  It requires but a
small amalgam filling to contain twenty grains of mercury,
which, if chloridized, will yield twenty-three grains of corrosive
sublimate.  Were this formed suddenly in the mouth, of course
the consequences would prove promptly fatal, yet it is the very
slowness of introduction that insures those fearful results
sometimes seen in consequence of the administration of mercury,
and which are acknowledged and detailed as minutely by its friends
as by its enemies, as in the celebrated fatal case of Scheele
already alluded to.  Some persons are much more readily poisoned
by mercury than others.  We have seen severe ptyalism caused
by a single three grain pill of blue mass; and we killed a
little girl of twelve years by the administration of six grains
of calomel, even though followed by an infusion of senna, so as to
induce early and prompt purgation.  And when a dentist uses
amalgam, he never knows but that he is inserting it into the
mouth of one of those patients so easily poisoned with mercury,
unless he has previously found by experiment that the reverse
is true.

We do not hope to see the use of amalgam fillings abandoned.
They come too handy for feeble men and lazy men; and oh!
the poor quacks!  Like Micah, in the book of Judges, they would
cry with an exceeding bitter wail, "Ye have taken my gods,
and what have I more?"  But just in proportion as the profession
make attainments in chemistry and pathology, will be the decline
in the use of amalgams.

We shall close as we began, by stating that the paper of Dr.
Talbot is both conclusive and timely.  When associated with
Professor J. Taft we tried all these experiments, substantially,
more than a quarter of a century ago, and they were to us so
conclusive that we declined then, as we had done before, to use
amalgam fillings, and notwithstanding slanderous statements to
the contrary, we have declined ever since, and neither of us has
ever found occasion to use, and neither has used amalgam fillings
in practice.

This late discussion of amalgam shows how little close thought
exists on the subject.  They talk of the way Dr. Townsend made
his amalgam, when they ought to remember that Dr. T. didn't make
it, and always so stated, telling all the while that he got the
formula from Dr. Wm. Hunter, of Cincinnati.