1882 Jan. 1 The chemistry and physiological action of mercury as used in amalgam fillings. E.S. Talbot 1899 Jul. Mercurial necrosis resulting from amalgam fillings. J.Y. Tuthill 1996 Mercury Dental "Silver" Fillings: The Debate Over Risk, Need For Replacement, and Detoxification. Ronald R. Parks, M.D.

Title: Talbot ES. "The chemistry and physiological action of mercury as used in amalgam fillings".

OHIO STATE J DENT SCI, 2(1):1-12 (Jan. 1, 1882)

[Read before the Illinois State Dental Society, held at Rock Island, May 10, 1881]

Abstract: The name Mercury was given by the ancients in honor of Mercurius, the messenger of the gods, whose volatile character mercury is supposed to typify. It is seldom found in the native state, but is usually combined. The most important as well as the most abundant combination is the sulphide of mercury, or cinnabar. It is found united with silver, forming an amalgam. The largest and richest mines are found in California. The process of obtaining pure mercury from the sulphide is very simple. The ore is mixed with one-half its weight of lime, and then distilled in iron retorts. The mercury is extracted and the lime remains in the retort. It is a heavy fluid metal, odorless, tasteless, of a whitish color, and when free from other metals it does not tarnish, and its globules roll freely over white paper without leaving a streak or losing their form. It is liquid at ordinary temperatures. It boils at 662 degrees F., and solidifies at -40 degrees F. into a malleable mass of octahedral crystals. It is volatile at all temperatures, evaporation being much accelerated by the application of heat. The symbol is Hg, atomic weight 200. Mercury combines with other elements and radicals in two proportions. Those compounds in which the LESSER acidulous radicals are united are termed mercurous. The higher mercuric -- thus, calomel (HgCl) is mercurous chloride; while corrosive sublimate (HgCl2) is mercuric chloride. Mercury combines with chlorine, iodine, bromine, lead, oxygen, phosphorous, sulphur, arsenic, bismuth, etc., forming compounds, some of which are used medicinally. The metal itself, rubbed up in confection of roses, licorice or suet until globules are not visible to the unaided eye, is used in medicine.

Amalgams were introduced into this country as fillings for decayed teeth in 1833. Since that time unlimited discussion has arisen among the general practitioners of medicine as well as the dentists, in regard to the practicability of utilizing this material in dentistry. The first amalgams were composed of pure silver and mercury, manufactured by M. Taveau. Later, Dr. Evans combined pure tin with a small quantity of cadmium, and Dr. Townsend formed an amalgam with four parts of silver to five parts of tin. Following these compositions came numerous others made from gold, silver, platinum, and tin, until to-day we have more than a hundred varieties in the market, varying slightly in metals and proportions, that each manufacturer may rightly claim an original preparation. These different metals are melted in a crucible in their proper proportions by weight, and poured into ingots. These are filed or cut into minute particles, ready for use. When the cavity in the tooth is prepared, a sufficient quantity of filings is rubbed up with mercury into a paste, the surplus mercury squeezed out, and the filling is inserted into the tooth.

From its first application as a filling the better class of dental practitioners waged war against it on general principles; not alone on account of the deleterious effects of the mercury in its composition, but because of its unsightly appearance and demoralizing effects upon the dental profession. The manner in which it was introduced into the country called forth the censure of all having a regard for professional etiquette: "Two adventurers, without skill or any claim to the title of dentist, suddenly appeared in New York and began dental practice amid such a shower of advertisements, a profusion of display, and a metaphorical flourish of trumpets, as caused our staid and dignified dental ancestry to bound with surprise and indignation". [vide History of American Dentistry]

From that time onward the use of amalgam has increased, until now tons are consumed yearly in filling teeth. Dr. Harris, in his opening address to the first class of the Baltimore College of Dental Surgery, in 1840, says: "It is one of the most objectionable articles for filling teeth that can be employed, and yet from the wonderful virtues ascribed to this pernicious compound by those who used it, thousands were induced to try its efficacy".

At the meetings of the dental societies this subject was spiritedly discussed with strong arguments against its use. The first official act in the matter was the appointment in 1841 of a committee by the American Society of Dental Surgeons to report on the use of lithodeon -- mineral paste, and all other substances of which mercury is an ingredient, for stopping teeth. They reported in substance that the use of all such articles was hurtful to the teeth and every part of the mouth, and that there was no tooth in which caries in it could be arrested and the organ rendered serviceable by being filled, in which gold could not be employed. This report was unanimously adopted. [vide American Journal of Dental Science]

At a meeting of the same society July 20, 1843, the use of amalgams was declared to be malpractice, and a committee appointed to further investigate the subject. They referred the matter to the Medical Society of the county of Onondaga, New York. The report of the medical committee was to the effect that no care in the combination or the use of the paste will prevent its occasional bad effects.

In 1845, the Mississippi Valley Association of Dental Surgeons resolved that the use of Amalgam fillings was unprofessional and injurious, and would not be countenanced by its members. The actions of the various societies had very little effect; amalgam forced its way into the offices of the majority of dentists in the country. Many excellent practitioners were expelled, and others resigned from the societies to which they belonged.

In 1850, a resolution was passed unanimously by the American Society of dental Surgeons to rescind the pledge made by the same society previously. Thus ended the so-called amalgam war. It will be observed that no scientific researches were made to ascertain whether deleterious effects were produced by mercury; the chief object of the disturbance was, apparently, to rid the profession of charlatans and their obnoxious materials. These discussions, which have caused so much bitterness and enmity among the members of societies, have latterly aroused a feeling of enquiry into the scientific analysis of this filling for teeth, resulting in the discovery of a quality in its composition capable of producing salivation, and all other symptoms of poisoning. Many able practitioners of dentistry have experimented with all the different acids with no satisfactory results. When we consider that nitric acid dissolves mercury at 60 degrees F.; concentrated sulphuric acid dissolves mercury only when heated; hydro-chloric acid does not affect it at all -- how can we expect the weaker acids of the mouth, diluted by saliva, to cause a chemical change?

If past experiments have proved unsatisfactory, it does not discourage me in the attempt to discover, if possible, by experiment and by the careful study of the subject of mercury in its every particular, some clue to this perplexing question. Having satisfied myself that the poisonous effects are not produced by the chemical changes in the mouth, I have entirely ignored this theory, and have looked about for a more simple and direct cause. In commenting upon mercurial poisoning, the idea has been advanced that the vaporization of mercury takes place only during the hardening process, and, that being consummated so quickly, no deleterious effects canoccur.

In the construction of an amalgam two changes take place, the first being the mechanical, or mixing together of the ingredients, the second the chemical, or hardening of the composition. My first experiment was to place metallic mercury in a four ounce glass-stoppered bottle, and submit it to the gold test, by suspending a piece of gold foil in the centre of the bottle, taking care that it did not come in contact with the sides, and cementing the stopper. I placed it under different temperatures, of from 20 to 130 degrees F. In about thirty-six hours the surface of the gold became coated with mercury, giving it a gray color. This proved the evaporation of the metal. I then mixed a quantity of the Chicago Refining Co.'s amalgam, according to their formula, three parts of mercury to eight parts of filings, and subjected it to the same test. The reagent was not sufficiently delicate to produce any perceptible change. Wishing to bring the highest chemical skill to bear upon the experiments, I consulted Prof. Haines, of Rush Medical College, who kindly assisted me. At his suggestion, I procured two delicate reagents, the ammonio-nitrate of silver, and the chloride of platinum. In preparing the ammonio-nitrate of silver, I allowed thirty grains of nitrate of silver to the ounce of water, and put a small quantity of the solution in the test tube. This was heated, and aqua ammonia added until a precipitate formed. Increasing the aqua ammonia until the precipitate cleared up, I took a quill and, with this liquid, wrote upon white paper. After putting the substance to be tested in the bottle, the strip of paper was placed across the mouth of the bottle, and the stopper cemented. Should a vapor arise, the liquid would become black. Leaving the bottle for ten minutes, I examined it again, and found the writing in plain black coloring. The chloride of platinum produced the same results, but required more time to accomplish it. The rapidity with which the evaporation of mercury takes place depends upon the amount of heat and the surface exposed, and not upon the quantity of mercury contained in the fillings. Thus a jar containing one quart of water would evaporate the same quantity as a jar of like surface containing a gallon, the latter taking four times longer to empty.

In the following experiments, I attached a thermometer to a water bath, and heated to the temperature of the body, 98 degrees to 100 degrees F., to maintain an even temperature. I conducted these experiments in the dark, as the rays of light decompose the ammonio-nitrate of silver. The strips of paper containing the reagent were placed in the mouths of all the bottles, including an empty bottle, which was used in each experiment, to prove there was no mistake.

Experiment No. 2 -- Three bottles were prepared. In the first was placed an amalgam filling made from Chicago Refining Company's amalgam, according to their formula. In the second was placed an amalgam filling of like size, containing five grains more of mercury. In the third bottle there was nothing. After a lapse of ten minutes I examined the bottles and found the writing on the paper across the mouth of bottles Nos. 1 and 2 was black, while there was no discoloration of paper in the third bottle.

Experiment No. 3 -- A repetition of No. 2, with the exception of the reagent chloride of platinum being substituted for the ammonio-nitrate of silver. The results were the same in both. The time required for the latter being ten hours, while but ten minutes were required for the ammonionitrate of silver. In conducting the remainder of the experiments the ammonio-nitrate of silver was employed, it being the more delicate reagent, consequently producing a more marked impression, and also consuming less time than chloride of platinum.

Experiment No. 4 -- Two bottles were prepared. In the first bottle were placed scraps of amalgam six months old. In the second there was nothing. In ten minutes the writing on the paper was black in the first bottle, and uncolored in the second.

Experiment No. 5 -- Bottle No. 1 contained amalgam fillings which had remained in the teeth from two to ten years. Bottle No. 2 was empty. The results in both being the same as in Experiment No. 4.

Experiment No. 6 -- In bottle No. 1 I put an amalgam filling which had been in the mouth sixteen years. In bottle No. 2 there was nothing. At the end of twenty-four hours I found the paper discolored in the first, and not in the second.

Experiment No. 7 -- To demonstrate that nothing in the composition of the fresh filings could cause the discoloration I allowed some filings to remain sealed in the bottle for twenty-four hours. At the end of that time discovered no signs of color on the paper.



Experiment No. 8 -- I procured four preparations of mercurious vivus.
No. 1	contained	1/10	gr.	mercury to	1 gr.	of sugar of milk.
No. 2	"	1/100	"	"	"	"
No. 3	"	1/1000	"	"	"	"
No. 4	"	1/1000000	"	"	"	"



A small quantity of each of these preparations was placed in bottles marked 1, 2, 3, 4. In No. 5 there was nothing save the reagent. The effect was alike in each of the four bottles containing the mixture. Those having the greatest quantity of mercury caused the deepest color to the paper and required less time. As before, No. 5 was unaffected.

In order to determine the difference, if any, in weight after evaporation, I obtained strong glass tubes one-half inch in length, and one-fourth inch in diameter, and packed them carefully with amalgam fillings. Allowing twenty-four hours for hardening, I weighed them, and at the end of three months I again weighed them, finding in some no change at all, and in others an increase in weight. This is accounted for by the fact that oxydation and accumulation of moisture on the amalgam equaled in some and exceeded in others the loss of weight by evaporation. I am in possession of numberless cases of poisoning from mercury in amalgam fillings. I will mention but one, and report one case from my practice.

The Dental Register, January, 1872, has the following case of poisoning from mercury in a tooth filling: "John T. Smith died from salivation, caused from having a tooth filled with amalgam. Dr. Sprague attended the case, and afterwards called Drs. Davis and Buffin, all of whom agreed that he was suffering from the effects of mercury present in the amalgam used in filling one of his teeth. The filling had salivated the unfortunate man, and, as the inside of his mouth, throat, and windpipe swelled, respiration was hindered, and finally ceased altogether. Dr. Davis made the post-mortem examination in the presence of the coroner and jury of inquest, opening the chest, taking out the lungs, and extracting the filled tooth. No signs of diseases were found, except that caused by the mercury, and it was made clear to the jury by the Doctor that this caused his death. The jury returned a verdict that the deceased came to his death by suffocation, caused by inflammation of the glands and infiltration of the tissues of the neck, producing closing of the traechea by pressure thereon; 'and we further believe that the above causes were brought about by the action of mercury, used in filling the second molar tooth of the right side of the lower jaw, by Dr. E. D. Keef, Marysville, Kansas.'"

A case in practice: A lady from one of the towns in Illinois came to Chicago for treatment, having been troubled with dyspepsia and nervous debility for two years. While under the physician's care she complained constantly of a peculiar feeling and taste in her mouth. The doctor suspected the trouble might arise from a rubber plate which she had worn for four years, and advised her to consult me. Upon examination, I found a full upper plate, composed of rubber, and on the lower jaw the molars were gone, except the second and third upon the left side. In the crown of the wisdom tooth was a large amalgam filling, and also one in the crown and posterior approximal surface extending to the free margin of the gum in the second molar. These had been inserted about two years previous. I noticed that the gums and the mucous lining of the mouth and salivary glands were quite tender. There was a strong metallic taste in the mouth, and a metallic odor to the breath. She had a peculiar paralyzed sensation in the left side of the tongue, which she had experienced for two years. She also informed me that the saliva flowed so freely that at night her clothing and pillow were saturated, and estimated the loss of saliva each night to equal one pint. I suggested the removal of the amalgam fillings and rubber plate, and substitution of gold. She assented to the proposition, and as early as possible I undertook the operations. Upon removing the amalgam fillings and applying the rubber dam, the saliva flowed in streams, completely saturating several towels. After refilling the teeth, and inserting a gold plate, the unpleasant sensation in the tongue and metallic taste disappeared. At the end of two weeks the glands were greatly improved, and the soreness under the tongue (of which she had complained at her first visit) was healed.

It is the accepted opinion of physicians generally, that mercury uncombined has no constitutional effect. Dr. Atkinson said before the meeting of the American Dental Association in Boston, August, 1880: "You must combine the molecules of mercury with some other agent before they can have any affinity for the body at all. One who is familiar with the old method of making looking-glasses, with tin foil and mercury, knows that the workman would be literally saturated with it, so that he could not be capable of handling a gold or silver watch without its becoming amalgamated, and all this, too, without his health being compromised by the mercury so long as it remains in a metallic state".

The correctness of this theory may be questioned, as it has been proven that these workmen have been affected by the vapor of mercury, when not protected by a veil over the mouth and nose.

Dr. Bartholow, in his work on Therapeutics, p. 177, says: "As used in the mechanical arts, by gilders and others, the fumes of mercury cause wasting, ptyalism, necrosis of bones, trembling, impaired intellect, and, in women, abortion". "Walter Pope mentions a workman who for six months had not handled mercury; yet he rendered a piece of copper as white as silver by rubbing it between his fingers". Parish says that long trituration of calomel increases its power to salivate. This is also applicable to all preparations of mercury used with an excipient, medicinally. The homeopaths divide and subdivide particles, according to the required preparations, some of the radical members of the school claiming best results from the highest potencies, while the more conservative practitioners prEfer a middle ground. They rub up pure mercury with sugar of milk into six different grades, the first containing one-tenth gr. of mercury to one gr.sugar of milk; the second, one one-hundredth gr. of mercury to one gr. sugar of milk, etc., as before mentioned in this paper. These are the finest forms in which mercury is prescribed, and yet the severest cases of salivation and constitutional symptoms have been produced by these agents, on account of their being so readily taken up by the blood. Is it not a reasonable supposition that, if poisonous symptoms are produced in proportion with the subdivision of the particles of mercury, that the system will be more severely affected by the vapor of mercury, which is finer than any mechanical subdivision can be? Dr. Somers recalls an instance of a lady patient becoming completely salivated, the gums and mucous lining of the mouth inflamed and teeth loosened, by taking a second bath, in which forty grains of the black oxide of mercury were used. He thinks she could not have absorbed one-twentieth of the amount in the form of vapor.

As a forcible illustration, I quote the experience of the sailors on board the man-of-war "Triumph", which, in April, 1810, took from the wreck of a Spanish ship thirty tons of quicksilver, contained in bags of fifty pounds each.

In the course of a fortnight some of the bags decayed and burst, the quick-silver mixing with the bilge water, the emanations from which coated all the metal about the ship. Nearly all of the crew were salivated.

In order to ascertain the effect of the vapor of mercury, I have employed it in a series of experiments upon plants and animals.

Experiment No. 1 -- While conducting my experiments in the laboratory I was frequently visited by a family of roaches, who appeared to take an interest in my operations. Suddenly they all disappeared, and it immediately suggested itself to my mind that their sudden departure argued favorably in the question of utilizing them in my experiments. I took four two-ounce bottles and put in No. 1 pure mercury; No. 2, amalgam scraps six months old; No. 3, fillings from two to ten years old; No. 4, fillings sixteen years old. After placing a roach in each bottle, I tied a piece of cloth over the mouth in order that the air might circulate. Evidently the bugs were not fond of mercury, for they clung to the tops of the bottles as long as life lasted. Roach in No. 1, containing pure mercury, died in three days; roach in No. 2 was next to follow; roach in No. 3 lived a few days longer; and in No. 4 outlived them all by several days.

Experiment No. 2 -- I prepared three bottles. The No. 1 contained ten grains of pure mercury; No. 2 contained an amalgam filling three months old; No. 3 was an empty bottle. In each of the bottles I put two roaches. In two days one in the bottle containing pure mercury died; the remaining one in the same bottle lived nine days from the time it was put in. In the bottle containing the amalgam filling one roach died in four days, while the other one died in eleven days; while those in the empty bottle lived fifteen and sixteen days.

Experiment No. 3 -- On February 9th I placed an amalgam filling at the base of a sensitive plant. On examination, about the fourth day, I discovered that the extremities of the leaves had changed color and were dry and brittle, like the leaves in early Autumn; gradually the whole leaf was affected, and at the end of ten days the plant was dead, notwithstanding the care and nourishment it received.

Experiment No. 4 -- In a four-quart glass jar I put about four ounces of mercury, and made a platform of wire gauze, fastening it two inches from the bottom of the jar. I placed a Guinea pig in the jar, and covered the top with gauze. Twice each day I removed him for exercise and nourishment. He thrived well for ten days, but at the end of that time he commenced to droop, and refused food and water. He became emaciated and trembling; the body and limbs were cold. He lingered along for two weeks and died.

Experiment No. 5 -- I administered six grains of mercurius vivus, first trituration, to a dog with his supper, and repeated the dose next morning with his breakfast. The blood and liver were examined under the microscope in the evening and found to contain globules of mercury.

It is the opinion of many eminent scientists that mercury inhaled into the lungs produces a greater effect than when taken into the stomach. Among this number Prof. Stille in his Therapeutics, Vol. 2, page 789, says: "Of the several modes by which mercury is made to enter the body, inhalation most speedily produces the specific influence of the medicine". Claude Bernard, late Professor in "Le College de France", makes the statement in one of his lectures. This is readily understood when we consider that the drug taken into the lungs in the form of vapor is distributed over a large surface and brought in direct contact with oxygenated blood, and thus carried to all parts of the body.

Mercury taken into the system in small quantities, long continued, manifests itself in a variety of ways. One of the first symptoms noticeable is an increased flow of the secretions of the body -- salivation being the most striking -- the glands becoming inflamed and the mucous membrane tender. The gums tumefy and change in color to a dark rose tint; the tongue is swollen; the patient not only experiences an unpleasant metallic taste, but the breath becomes impregnated also. Sometimes extensive ulcers attack the throat, gums and cheeks; oedema of the glottis, with difficulty in breathing and swallowing. The digestive apparatus is involved, with loss of appetite, nausea and vomiting, and frequently pain and tenderness of the stomach; the bowels loose, and often bloody stools. The fatty constituents are removed, and the patient becomes emaciated; no part of the body is more affected by mercury than the nervous system; the body trembles; sometimes one limb, and again both limbs contract. A sense of coldness and occasional chills are experienced; often neuralgic pains are felt, particularly around the motor nerves; mental debility and loss of memory. These are some of the many symptoms caused by the inhalation of the vapor of mercury.

Resume

There are in the market many varieties of amalgams. Evaporation does not depend upon quality or age, but all amalgams will send off the vapor of mercury. This has been proved conclusively by its destruction of animal and vegetable life, and by chemical tests. Evaporation is facilitated by an increase of surface, consequently a greater amount of vapor would arise from several small fillings than from one large filling. The facility with which mercury is taken into the lungs by continued inhalations and the rapidity with which it enters the blood, requires less mercury to produce systemic effects than when taken into the stomach. In order to produce systemic effects from metallic mercury, it must be rubbed up with an excipient, to reduce the particles to a size capable of entering the capillary system, or it must be taken into the lungs in the form of vapor.



The dictionary definition for the following article as published in 1913:

Necrosis
Ne*cro"sis (?), n. [NL., fr. gr. , fr. to make dead, to mortify, a dead body.]
1. (med.) Mortification or gangrene of bone, or the death of a bone or portion of a bone in mass, as opposed to its death by molecular disintegration. See Caries.--now used differently : modern def = "pathologic death of part of a tissue due to irreversible damage" i.e. not just bone. Contrast to necrobiosis, which is a normal death of cels in a tissue --
Caries
Ca"ri*es (?), n.[L., decay.] (Med.) Ulceration of bone; a process in which bone disintegrates and is carried away piecemeal, as distinguished from necrosis, in which it dies in masses.
Neurosis
Neu*ro"sis (?), n.; pl. Neuroses (#). [NL., fr. gr. nerve.] (Med.) A functional nervous affection or disease, that is, a disease of the nerves without any appreciable change of nerve structure.-- (psychiatry) a mental or emotional disorder that affects only part of the personality, and involves less distorted perceptions of reality than a psychosis. It includes certain anxieties and phobias. [MW10] --


Tuthill JY. "Mercurial necrosis resulting from amalgam fillings". AM J DENT SCI, 33(3):97-118 (Jul., 1899).

Mercurial necrosis is a field of pathology which has not received the investigation it deserves by the medical profession. While the poisonous effects of mercury have so long been recognized that I need take no time in rehearsing them, yet there are certain causes affecting the nerve centers which demand more thorough investigation than has yet been given.

In presenting this subject to the Society for consideration I want to show that by the use of amalgam in filling teeth there is a possibility of mercurial poisoning, which seriously affects the nerve-centers, impairs locomotion by heaviness of limb and stiffness of joint, gives rise to obstinate diseases of the skin, and makes a mental wreck of its victim, whose imaginations and hallucinations are more than my pen can describe.

Physical examination reveals nothing to assist the physician in making a diagnosis of his case, as all the functions are usually well performed. There is, however, nervous depression, irritability, unreasonableness, an inability to overcome and throw off feelings of oppression which settle upon the patient and hold him as in the clutches of despair until his ambition is broken, his energy is gone, his purpose is lost, and he drifts for lack of power to concentrate his actions and assert himself as a force in the world. There are shifting, shooting pains here and there from head to foot, affecting sometimes one part and then another; numbness of hand, foot, or jaw, heaviness of leg, arm, or head, with an almost inability to move them, and a feeling as though one would fall or lose consciousness. Again there is a light, floating sensation as though moving in air. There is mental excitability as well as mental depression; perplexing events cause the highest degree of excitement, ordinary conversation sometimes causes complete confusion, headache, palpitation, intense solicitude, and anxiety, without reason for it. Such are some of the symptoms attending these cases.

To bring this pathological condition more clearly to your thought, allow me to cite a few cases which have come under my observation during the past few years, and you will pardon me for alluding to my own individual case which first opened my eyes to this subject.

During the winter of 1884 and 1885, when working far beyond the limits of good judgment, and averaging from October 15th to April 27th, not more than from four to four and one half hour's sleep per night, I was attacked February 1st with neuralgic and rheumatic pains, usually short in duration, lasting from ten to fifteen minutes to three or four hours, affecting chest, back, arms and legs. My work was arduous, and the professional demands upon my time and strength prevented my getting adequate rest. With failing strength and energy, I continued my daily routine of work until April 27th, when I was in a state of physical and mental collapse. I sought a quiet place for rest, and April 28th went to Saratoga Springs. Arrived there at 3 p.m., and in a half an hour was in bed. I had a good night's rest, and after breakfast the following morning took a stroll through the village, which at this season of the year is the sleepiest place of its size that I know of. Then, thought I would write home news of my safe arrival and a good night's rest. But never was I more surprised than to find that I could not write more than two or three words when my hand would be so numb that I could not hold the pen, until I had rubbed it for some minutes. The same processes were repeated over and over again until I had succeeded in writing a short letter. This condition continued, with some abatement, for many weeks and, in much less degree, for years following. I remained in Saratoga for ten days, sleeping thirteen and fourteen hours in every twenty-four, then returning home and resumed practice feeling much improved.

An eruption which appeared like psoriasis, and which had troubled me for several years, became more troublesome and refused to heal, much to my annoyance and chagrin. All the foregoing conditions continued up to the spring of 1889, when a persistent headache, often of neuralgic character, continued for two or three months was relieved by taking a four months' trip abroad.

Since that time I have had average health, with occasional numbness of hands. The handling of steel would almost paralyze my hands for some minutes to come. The eruption continued the same, resisting all treatment that my own ingenuity could devise or that my professional brethren, who took a kindly interest in my case, suggested.

The numbness attended with pain in the fingers, was thought to be a form of gouty neuritis. Following their advice, I took such remedies as they prescribed, sometimes it seemed for the better, but with no permanent improvement.

In the summer of 1895, spending the month of August on the Shawangunk Mountains, I was applying to the eruption bichlorid of mercury, which accomplished more for healing than anything I had ever used; but while the eruption was fast getting better, my hands were rapidly losing their power and I could not rely on holding anything, nor could I pick up small things like pins, needles, or twine, because of the numbness. At this juncture, it occurred to me that I was absorbing mercury, and that mine was a case of mercurial neuritis or paralysis, the result of this absorption, and that the eruption was a mercurial psoriasis. Returning to the city I laid the matter before several physicians, who thought I was mistaken, as my gums showed no evidence of mercurial poisoning, and on their advice resumed the use of the bichlorid lotion, but was compelled to abandon it in a few days because of numbness which followed. I reported my condition. They then agreed with me that the mercury affected my system in an unusual manner, but thought that I had an idiosyncrasy, and that it would probably not affect more than one in a thousand under the same circumstances.

Being thoroughly aroused as to my state, and having several amalgam fillings in my teeth, I soon came to believe that my entire condition, the numbness, the rheumatic pains, and the eruptions were all due to the action of mercury absorbed from those fillings. So I decided to have them removed, and the work was done in May, 1896. In two weeks I felt like another man; it seemed as though a great weight had been lifted, and I was once more free from an oppression which had hung over me like one long nightmare for years, handicapping, restricting, and restraining me on every hand.

My improvement has continued from that time to the present, the numbness growing less and less, the eruption disappearing until there is less of it than at any time in fifteen years.

I do not imagine that all the mercury that I absorbed from those fillings which I carried for thirty-eight years is out of my system; but from my general improvement, believe it is growing less all the time, and I am feeling better now than at any time since the spring of 1885. Having lived for eleven years on the ragged edge of hope and despair, and thus secured my freedom from a bondage worse than human slavery, I could appreciate the sufferings of others when rehearsed experiences which I had realized. As a natural consequence, I readily recognized the same enemy to their peace and happiness which had shattered my own.

In December, 1896, I was called to see Miss F., aged thirty-three years, who had been in excellent health previous to an attack of la grippe in December, 1892. Since then her nervous system had been much disturbed, and she had come to be melancholic and to withdraw herself from her family and friends, seeking the seclusion of her room -- refusing to go out or to associate with others, or even with the members of her own household. When I was called, she had been treated by five different physicians with no improvement. I treated her for indigestion, torpid liver, constipation, etc., for ten weeks, with no improvement in her mental condition. Then numbness of hands and stiffness of jaws led me to examine her teeth, when I found five amalgam fillings which I believed had produced a mercurial neurosis. I gave it as my opinion that her condition was due to the effect of mercury upon her nervous system absorbed from those fillings and advised their removal. She was stubborn and for some time refused, but yielded in May, 1897, and had the work done. She has steadily improved since that time, and her family say that she has not been so well in five years as now.

Case 2. In the early part of last September, Miss E., aged eighteen, was brought home from a three-months sojourn in the country, with all the indications of typhoid fever. Intestinal antiseptics, tonics, etc., arrested the progress of the case, but an unaccountable languor, debility, loss and flabbiness of flesh with drowsiness, continued for several weeks, she sleeping eighteen and twenty hours out of twenty-four. My case otherwise appearing well, her sluggish gait, heaviness of limbs, and stiffness of jaws, led me to examine her teeth, in which I found nine amalgam fillings. Being convinced that these were retarding her recovery, I advised their removal and the substitution of gold. When the fillings were taken out she became more wakeful and animated, and has continued to improve although still suffering from the effects of the absorbed mercury.

Case 3. Miss K., a young lady of culture and refinement, was brought to my office December 1st, 1887, suffering from extreme nervousness, which had continued for three years. She was restless and could not apply herself for any length of time to any one thing, sleepless, irritable, hysterical, etc. Having made a thorough examination of her case and being assured that all of her functions were normal, I examined her teeth and found sixteen amalgam fillings, several of them in teeth containing gold fillings. Believing this to be a case of mercurial neurosis I told her, and her mother who accompanied her, that the case put me in mind of what I had read in "Ziemssen's Cyclopaedia" a day or two previous on mercurial poisoning, and I read to them, viz.: "Essentially the condition is characterized by great mental excitability of the patient to external impressions. Every unexpected or perplexing event excites him in the highest degree. The visit and the conversation of the physician put him into a state of complete bewilderment, even to syncope; the adult patient grows pale and stammers in answering the simplest questions. To perform his allotted task requires the greatest effort, or is even impossible if he sees or thinks he is being watched. There is also great solicitude and a feeling of anxiety without any reason for it. There is sleeplessness, or sleep which is restless, frequently broken and disturbed by frightful dreams, headache, and palpitation. In the severer forms there are frequently hallucinations, usually of a frightful nature. When perplexed or excited, traces of tremor are often perceptible in a slight twitching of the muscles of the face at the corners of the mouth". Having heard this, she remarked that it was a perfect description of her case in every particular, except that she had not had the hallucinations there mentioned. Following my advice the fillings were removed and the young lady has improved very rapidly to the present time, all her nervous feelings having disappeared. Indeed, her mother tells me that she manifested none of her nervous troubles since the removal of the fillings.

Case 4. In February, 1897, was called to see Mrs. N., who was extremely nervous, with neuralgic pains in the chest and palpitation of the heart. Upon looking up she felt as though she were falling backward. Had heaviness of limbs, loss of memory, and found it difficult to think and harder still to put her thoughts into words. Numbness of hand or foot, a sensation of floating, and a feeling that she would die, were common experiences. I did not see her many times before I examined her teeth, and found one large amalgam filling in a lower molar, which I advised her to have removed, but doubting its necessity she kept it until November. Here I wish to read a letter sent me several weeks ago:

DEAR DR. TUTHILL:

"I wonder if there is another woman in this world who has had all the peculiar feeling that I have had within the past two years? You know that I am one of the healthiest-looking mortals, have good appetite, sleep fairly well, etc., yet for all this time I have suffered from such awful feelings. I was afraid to go out alone, or be alone, and in constant fear that something dreadful was about to happen. I suffered much from palpitation. Sometimes, when sitting in a street-car, the people would suddenly begin to look queer, the car crooked, and I would look around at each one to see if any one realized the dreadful condition of things. I had also light, floating sensations, and at times it was hard to talk, to think, and speak in sentences. When lifting my eyes upward I felt as though I were falling backward. Then my limbs were so heavy, my memory seemed to be gone, and I often felt dazed. Even when conversing with friends, or sitting at the dining-table, such a horrible feeling would suddenly seize me and I thought that in a moment I might fall down dead. I became hot and cold and sick, and would have to rise and walk about till it passed over. The feeling that I was just about to die often came to me with sensations that I cannot describe, but such as I should imagine a person dying would have. It began at my feet, a numb, cold creeping feeling, and seemed to be hardening all over. Two or three of these spells I would have in a day, lasting from ten minutes to half an hour.

"You told me last spring that if I would have an amalgam filling in one of my teeth removed, a large part and perhaps all of these nervous troubles would disappear. But it seemed too absurd to me that I hardly gave it a thought till you urged it again this fall. While my husband was in one of the Western cities he happened to be in a large Dental Association and asked the president if he had ever heard of amalgam fillings causing nervous troubles. He replied, 'Yes we have. It is not common, but some people are poisoned by the mercury, as I can prove', and then cited the case of a man in that city who was a nervous wreck, given up by several physicians. At last one doctor said he believed him to be suffering from mercurial poisoning, and, upon examination, found seven amalgam fillings in his teeth. They were removed and from that day the man began to improve, and is a strong, well man to-day, scarcely knowing what a nerve is.

"So my husband wrote to me to take your advice and have the filling removed. I did so about two months ago. Immediately I felt better and coming home felt as though I could have walked to Beersheba and not have fallen. My buoyant feelings have not lasted, however, and some days I am almost discouraged. But I know that I am better. I have not had one of those awful dying sensations, nor do I have nearly so much of my nervous troubles. I can go downtown and to New York and do many things that I could not do before I had the amalgam filling out. Still I do have days of some of the old feelings and fears, but they pass away more quickly. I am living in hopes that it will be as you said, 'They will all be gone to stay away, in time'. But as the filling was in two and a half years, I could not expect to be cured in two months.

"Oh, Doctor, how I wish I had taken your advice last spring and saved myself the sufferings of the summer and fall! I wish I had never had it put in my mouth. No dentist would put in another for any amount of money. I want to thank you with all my heart for insisting upon my having that filling removed and bringing brightness again into my life. Days when I feel well I am the happiest woman living. I only long to feel entirely well, and trust as the poison passes off that I shall.

"Very gratefully yours,

Mrs. N."

Case 5. In July last I was called to see Mrs. H., aged twenty-six, who was in a very excitable condition, afraid to go out alone in the street or stores lest she become unconscious and be taken to some hospital. Upon looking up she felt as though she were falling backward; when looking down, as though falling forward; when standing still, as though she were going to pieces; when lying in bed, as though floating toward the side wall; when sitting in a chair she often felt as though she were dead all over, and that it would require the greatest effort to make any movement. Her troubles began in the fall of 1895, with pains in the back of her neck and about the lumbar regions followed by pains in her left thigh and arm, which would last from a minute to one or two hours and then pass off to reappear there or elsewhere at irregular intervals. In the spring of 1896 she complained of stiffness of the jaws, of her left hand and foot going to sleep, with continued numbness of the third finger of the left hand. The left side of her head and the left ear would often become numb. The large toe on the right foot would be numb for weeks at a time. She also complained of her limbs being heavy, like lead, and at times it was difficult for her to raise them. There was loss of memory, the eyes looked dull and heavy, the skin had a dingy look which washing did not improve. Feelings of dread and fear lest some calamity might befall her, made her afraid to stay in or go out alone, which she had ceased to do for more than a year. I treated this lady for several weeks without making any progress on the case. Then I examined her teeth and found nine amalgam fillings, which I believed had more to do with her condition than anything else. I therefore advised the removal of the fillings and that they be replaced with gold or bone. The work was done. In less than a week she began to improve; in three weeks you would hardly have believed her to be the same woman. All her symptoms have abated; the numbness, the heaviness of limbs, the constant fear, the falling tendencies, the stiffness of jaws, have disappeared, and she goes out alone. There is a buoyancy and vivacity in her manner which shows that her hopes and anticipations are bright. Her skin looks clear and healthy, her eyes sparkle with expression, while her memory is true to her as in former days. Since the removal of the amalgam she has gained twenty pounds in weight. I might say in passing that nine physicians had treated this case before it came to me.

I might describe several other cases, in one of which the fillings were in between twenty-five and thirty years, and the toxic effects manifest for a dozen years; but those already given are a sufficient illustration.

Members of the dental profession who are so freely using amalgam tell us that over the surface of each filling there is an oxidation which prevents any possible absorption of the mercury. Fillings which have been removed are bright, where in contact with the cavity, indicating that this oxidation occurs only to the exposed surface and not to that which comes in contact with the structural parts of the teeth. The circulation in the teeth is continually in contact with the unoxidized surfaces of the amalgam and is constantly receiving some mercurial taint which is carried throughout the system. As the nerve-centers are most impressionable to its toxic effects, we find neurasthenic conditions chiefly resulting.

It is not my purpose at this time to indulge in theories as to how these results follow the use of amalgam, but to merely state the facts. While many having these fillings seem to be exempt, others suffer from the subtle effects of the mercury. This is clearly proven by the cases I have cited, which have come to my knowledge during the last two years. So long as the system keeps in vigorous condition many feel no ill effects of the poison, but when from any cause it falls below par, either from over-tax or from disease, the toxic effect of the mercury becomes dominant, with those susceptible to it, and gets the mastery of the nervous system, to be followed in many cases by the train of symptoms mentioned above.

Although the number of cases may be comparatively few, they deserve as thoughtful consideration as would be given the subject if mercurial neurosis were more common. I doubt not that our insane asylums have many an inmate of a mental state developed by amalgam fillings, which produces excitation or sluggishness of brain, impairs thought, destroys memory, blunts perception, and relegates to despair what otherwise might be a bright and brilliant career.

To insist upon a patient's enduring the agony, torture, and expense of having these fillings changed for gold, requires considerable nerve, with positive assurance of a correct diagnosis, for in case no improvement should follow the physician would be a subject for wholesale condemnation, and branded as a crank. Fortunately for the writer, in no instance has he advised the removal of these fillings where a marked improvement has not followed in a few days. It would be unreasonable to expect the relief to be complete and immediate, for the removal of the fillings does not remove the mercury which has been gradually absorbed into the system during months and years of contact with the amalgam, and which has seriously affected the nerve-centers. But it does stop the supply, and when that is cut off there is an abatement of all the more prominent symptoms, followed by a marvelous improvement, and the patient realizes that he is living under new conditions, with hopes and aspirations he has not known for long months and perhaps for years past.

For the conscientious physician too obscure and unsuspected causes of disease have a peculiar interest, and he will not allow prejudice to prevent a careful investigation of the facts which may reveal such causes.

If this paper shall but stimulate some present to a more earnest study of this subject it will have fulfilled its mission and put into motion a train of thought which must eventually secure to many a now hopeless sufferer a relief so great as to be almost the beginning of a new life.

DISCUSSION

When our President asked me to take part in this discussion, and told me that I would be allowed ten minutes, I determined I could cover more of the enormous ground involved, and in a more connected manner, if I should read what I had to say.

About the year 1826, M. Traveau, of Paris, France, advocated the use of what he called "Silver Paste" for permanent fillings in teeth. This metallic preparation was first brought to the notice of the dental profession in the United States about seventy years ago through the advertisements of two Frenchmen by the name of Crawcour.

It was called by them the "Royal Mineral Succedaneum"; succedaneum, a replacer or substitute, a name which is indicative of fraud and which consequently stamps the adventurers as unworthy of professional respect.

It was soon proven that instead of being a mineral compound it was purely metallic, and consisted of silver and copper rendered temporarily plastic by the addition of mercury. It was easily manipulated, and they were enabled to fill a class of largely decayed teeth with frail and broken cavity walls such as had never been attempted by the most skilful surgeons.

Scientific investigation at last was imperative, and, as a result, the foremost men who had been arrayed against it now became its ardent supporters. Professor Elisha Townsend, one of the best gold-workers of his day, and President of the American Society of Dental Surgeons, found that the cry of mercurial ptyalism was not supported by fact.

This investigation gave birth to an organization called "The New Departure Corps", and was composed by the following gentlemen: Professors Henry Morton and M. B. Snyder, scientists; Messrs. Jacob B. Eckfeldt and Patterson Dubois, assayers of the Philadelphia Mint, metallurgists; Drs. S. B. Palmer, Henry S. Chasee and J. Foster Flagg, dentists. The work of this organization gave to our profession what is known as the new-departure creed, the most important deduction of their work being expressed in the following statement: "In proportion as teeth need saving, gold is the worst material to use".

These gentlemen did much to improve the formula for amalgam alloys and it has gone through successive changes until now we recognize the following to be as good in all respects as we can get: Silver from 60 to 70; tin, from 30 to 35; and gold and zinc from 5 to 10. These are about the proportions. These metals are melted in a crucible and thoroughly stirred while in a molten condition, and then poured into a mold. After the mass has become cold it is cut into fillings with a file and we then have the alloy.

To make an amalgam for filling a cavity the required amount of alloy is placed in one side of a pair of weighing scales, and an amount of mercury in the other sufficient to balance the scales. Both the alloy and mercury are now put into a mortar and very thoroughly mixed, after which all possible mercury is squeezed out through chamois with heavy pliers, and the amalgam is now ready for insertion into a PROPERLY PREPARED CAVITY.

An ordinary sized cavity will require 5 grains of alloy. After adding 5 grains of mercury and thoroughly mixing, 1 1/2 grains of mercury can be expressed through the chamois, leaving 3 1/2 grains of mercury in a filling of 8 1/2 grains. This is in a cavity with entire walls. In cavities where where contour fillings are required the amount of mercury will be slightly increased.

The object of putting an excess of mercury in the mixing, and then expressing the surplus, is to facilitate a complete and thorough amalgamation, while expressing of the surplus removes only the mercury, no portion of the other metals passing through the chamois.

Such a filling placed in a PROPERLY FILLED CAVITY makes what all dentists recognize as a good filling, and from which no mercury can be removed so long as it remains in the mouth. This, I believe to be the consensus of opinion of all scientific practitioners of dentistry throughout the world.

It is claimed, however, that the mercury DOES get out and is absorbed into the system, producing mercurial neurosis, ptyalism, etc.

If any of the mercury could be removed from such a filling it would no longer be a fit stopping for a tooth. It would be disintegrated, soft, and would fall out, either by mastication or the toothbrush. We do not however, find amalgam fillings acted upon in this way. Fillings that have done good service for thirty years are always as hard as the day they were inserted. The mercury CAN be removed by heat and by chemical affinity, neither of which can be produced so long as they remain in the mouth. The boiling-point will not eliminate it, and as the tissues of the mouth will not tolerate anything approaching that temperature, heat is excluded.

I am reminded here of a letter recently received from Dr. Bogue, in which he says, in reply to my question about the action of iodide on amalgam: "I did not make any experiments at all relative to the systemic effects of iodine upon mercury which had entered the system from amalgam fillings in the teeth -- perhaps because most of the patients for whom I had the honor of operating have not during my time been subjected to a dull red heat, which is about the temperature required to produce either of the two poisonous salts of mercury".

Messrs. Woodman and Tidy, in their work, on "Forensic Medicine and Toxicology", make the statement that the following medicines have sometimes produced salivation: Bromin, arsenic, prussic acid, nux vomica, cantharides, digitalis, conium, opium, and particularly iodid of potassium; and in the face of all this the mercury in amalgam fillings is made to bear so great a burden.

Professor A. Winter Blythe, in his work says, in speaking of amalgam, that the mercury is in TOO POWERFUL A STATE OF COMBINATION to be attacked by the fluids of the mouth.

That serious consequences will sometimes follow the insertion of any filling material placed in the cavity of a tooth, I will admit, but such results are not due to the NATURE of the FILLING MATERIAL, but to the CONDITION of the tooth at the time of filling. The first of these are caused by the pressure of the fillings on an exposed pulp; the second is where a filling is inserted over a devitalized pulp; and the third is where the pulp has been removed and the canals not properly sterilized.

The results from this method of fillings are facial neuralgia, shock from thermal changes, pain on percussion, pericementitis, alveolar abscess and great cellulitis, elevated temperature, fetid breath, and excessive flow of saliva, with corresponding constitutional depression. When amalgam had been used in a filling of this kind, all these conditions were said to be caused by the mercury in the amalgam, but ANYTHING that will hermetically seal a cavity containing septic material, will, on true surgical principles, elevate the temperature, the same as an abscess in any part of the body containing septic material with no outlet.

The question that is constantly asked of me is, "How great a loss of mercury is sustained by an old amalgam filling?"

This is most thoroughly exemplified by a wonderful series of scientific experiments, in a masterly work on that subject, and as the author of that book is in the room he will explain it far better than I can.

In a letter recently received from Dr. Jarvie he says, "I have practiced dentistry for thirty-five years, and have yet to see the first case where injurious results have attended the INTELLIGENT USE of amalgam".

Far greater than any series of scientific experiments can possibly be, is the fact that tons and tons of amalgams are used every year, and no injury has ever been proven to be caused by it.

In J. Foster Flagg's work on "Plastics and Plastic Filling", in looking for some scientific experiments, he says:

"I found reference made to the practical experiments of Messrs. John and Charles Tomes, in 1861 to 1872, which I had regarded as conclusive and accepted as such. I found the term 'oxidation' as almost invariably applied to the discoloration of amalgam fillings, corrected by the acceptance of the long before urged, and much more reasonable hypothesis of 'sulphuretting'. I found a long list of elaborate experimentation with filled teeth and amalgam pellets, weighed with marvelous accuracy, placed in little bottles containing saliva acidulated with nitric, acetic, citric, or hydrochloric acid, and kept in a water-bath inside another water-bath at a uniform temperature -- blood heat -- for a period of three months, in order to prove by analysis of the saliva whether or not amalgam fillings would be capable of producing mercurial ptyalism. I could not reasonably doubt the certificate of the Professor of Analytical and Applied Chemistry that the saliva contained no mercury in solution".

In speaking of the systemic effects, the author quotes from a discussion held in the Pennsylvania Association of Dental Surgeons, as follows:

"Dr. C. N. Pierce, one of the professors of the Dental College of Pennsylvania, who opened the discussion, said in regard to amalgam, ptyalism, that it was a thing of 'so rare occurrence that he believed the profession had never heard of but one practitioner who thought that the result was produced by amalgam'".

Professor T. L. Buckingham said, "he had never seen a case of salivation and had doubts about its ever having produced ptyalism"; that mercurial effects were "influences produced through the general system, and he did not think amalgam fillings would produce these effects".

Dr. J. H. McQuillen said that "in an experience of fourteen years he could not recall a single instance of necrosis of the jaws, ptyalism, etc., of which others assert they have seen so many"; and that while he recognized the fact of idiosyncrasies in which the smallest quantity of certain medicinal agencies is followed by untoward results, and would not, therefore, offer his negative testimony as positive proof, yet "his own experience had made him look upon those who assert that they have seen so many cases with considerable doubt as to the value of their judgment or opinions as reliable diagnosticians".

Dr. C. P. Fitch said, "in regard to its toxical or injurious effects upon the system, he was inclined to question, if not wholly doubt, any such influence, and concurred in the views advanced by Dr. McRuillen, that he had yet to see the first case of alveolar abscess, ptyalism, etc., due to the presence of mercury in the amalgam".

Dr. J. M. McGrath testified for himself and for his father, who had had an amalgam experience of ten or fifteen years, that as yet "they had never seen any bad effects resulting, such as had been ascribed to its use by many practitioners".

Dr. Flagg says: "Thus it was that I was fortified by the combined testimony of gentlemen whom I could esteem as conscientious observers, and for whom I had much regard, both socially and professionally. It now remained for me to add the testimony of almost thirty years more of increasingly acute scrutiny (this book was written ten years ago), with the assertion that during all of my amalgam experience I HAVE NEVER SEEN ONE CASE of mercurial ptyalism, mercurial periostitis, mercurial necrosis, or of the SLIGHTEST SYMPTOM WHICH COULD REASONABLY BE ASCRIBED TO MERCURIAL ACTION. I have treated them experimentally with chlorate of potassium to demonstrate its utter impotency, and have then CURED EVERY CASE without the use of any anti-mercurials and have left the teeth refilled with amalgam. If anything more convincing than this is required, I have it not to offer".

I have before me a very elaborate series of experiments on "The Physical Properties and Physical Actions of Dental Amalgam", by E. A. Bogue, M. D., D. D. S., of New York, now known as Manhattan. If Dr. Bogue is present we should be very glad to hear from him.

In the first place, the dentine of the tooth has a circulation like a vegetable, and only that; the cementum of the tooth has a circulation like bone; the enamel, I need scarcely say, is skin to crystal. It is plainly stated in "Wood's Therapeutics" that minute doses of mercury increase the weight and increase the number of red blood corpuscles. So far, therefore, from being detrimental, it would seem that a thirty-eight years' wearing of amalgam fillings ought to have helped him. Perhaps it is that that enabled him to work eighteen hours a day! I do not see that such a supposition on my part would not be quite as susceptible of proof as the assumptions on Dr. Tuthill's part that these neuroses of which he speaks arose from amalgam fillings.

Then as to the power of mercury from amalgam to penetrate into the system. In the first place, the amalgam filling should be a chemical combination. It should not be a mere loose mechanical mixture. If it be a chemical combination, it is impossible to separate the mercury from the mass short of a heat very nearly approaching redness, excepting it be a dry heat. I did go through a series of experiments, which I have looked over tonight for the first time in twenty years, and I am ashamed of their elementary character, but at that time -- in 1873 -- we knew very little of amalgam fillings. It so happened that two gentlemen then connected with Harvard University, and a third connected with the University of New Orleans had written certain papers which were read and discussed. In the course of my experimentation I kept a whole handful of amalgam fillings at 100 degrees F for three months, in saliva, for the purpose of finding out what the effects of certain chemicals were upon the teeth in connection with amalgam fillings. Perhaps, if I might be allowed, I will tell the reason that caused me to commence these experiments. A gentleman of great prominence in the now Greater New York placed his son in my hands for treatment and for a curious reason, declined to pay my bill. He sent him to some one else to have the amalgam fillings which I had put in taken out. This is history. He then sent a letter from Dr. Metcalf, Professor of Theory and Practice at the College of Physicians and Surgeons, New York, to me, with the statement that his son was suffering from mercurialism from the presence of amalgam fillings. That boy had but one amalgam filling in his mouth, which had been there a number of years -- a tiny thing, about as large as a pin's head. I replied to Dr. Metcalf that the boy was not suffering from mercurialization, but from chronic dyspepsia due to his inability to masticate properly -- rather a saucy thing to say to a Professor of Theory and Practice. Dr. Metcalf took it kindly, however, and in a letter inquired of me whether it would not be possible for the emanations from amalgam fillings to produce systemic results. Thinking the question easy to answer I laid it by to the next day, and the next week, and in fact it was unanswered for twelve months, all of which time it took me, besides four or five hundred dollars in cash, before I was able to satisfy myself with an answer to that question. Then came the analysis made by Professor Chandler, of Columbia College, in which, as has been stated, he certifies that there was no mercury to be found in any of the bottles of saliva, which for three months had been kept at 100 degrees F, and contained, as I said before, a handful of amalgam such as dentists use. That report was made just after a little extract from the "Chicago Medical Journal" for July, 1873, had been put in my hands, in which was an article by Dr. Paine, in which he speaks of "the poisoning of thousands of people all over the world from corrosive sublimate generated in the mouth from amalgam plugs in the teeth; neither cholera, small-pox, or any malarious disease doing more injury in the world than this poison". That is broader and stronger than any statement that has been made this evening, and it was in answer to that and to Dr. Metcalf's very kindly question that these experiments were undertaken. I would only add that it is quite possible to eliminate mercury from amalgam fillings when they are dry, but when they are under saliva, or under water, it has not been found so in three-months' time.

I have been in practice for a number of years and have been looking for these cases of salivation. I saw last October a case that I thought was a typical one, but every filling in his mouth was gold. I saw another case only last month, and that man did not have a single filling in his mouth; so I hardly think that can be charged to the amalgam. The statement was made that amalgam fillings when removed are found to be bright on the side which comes in contact with the walls of the cavity. I think you will find they are as perfectly oxidized there, or "sulphuretted", as they are on the outside.

Mr. President, either mercury produces, when absorbed from the teeth, an entirely different clinical picture than when absorbed from the other parts of the system, or there is a discrepancy in Dr. Tuthill's cases. As he read them off they reminded me more of miscellaneous cases of neurasthenia and hysteria than anything else, and the rapidity with which they changed their character from time to time; the variability of the symptoms and the extreme rapidity with which they got well, even after existing for years. A mercurial poison which has existed for years almost invariably produces a continuous trmor due to the deposit in the nervous system and accompanying sclerosis. Had these cases lasted for so many years there would have been the production of some organic change there and the condition would not have cleared up so quickly. I think the last speaker is quite correct regarding the element of mind-cure. I think that was the potent element which produced the cure in those cases.

We all admit that there is a circulation in the teeth which may be the means of carrying the poison through the system, and this kept up for weeks, months, years and decades, the system will feel the effect of this poison. I tell you, gentlemen, no one knows the direful consequences if he has not been there himself. Of course I am more interested in this subject, for it came near costing me my life.

I have often thought how the fathers in dentistry wrought well when they fought to the bitter end this subject of amalgam fillings; how they wrestled on the one side to prove it harmless, and on the other to expose its treachery and condemn its use. The struggle lasted from 1841 to 1847, when in the New York Dental Society all who had not pledged themselves not to use amalgam were obliged to resign or were expelled. Those who had been the best of friends became bitter enemies. I hope that the same conscientious feeling which prevailed then will prevail again.

I would like to say a word on that point. I think at present there is hardly a dentist in practice in the entire world but habitually uses amalgam; they have all overcome their prejudice to it. There is no more danger of that fight being renewed than of any other absurd thing.

I do not claim for this particular effect of mercury that you get salivation. There is no ptyalism present; I never saw it in one case, but, as I said in my paper, there is a peculiar action upon the nervous system. The theory that recovery was due to mind-cure is too absurd for consideration with the cases I have cited. I have seen people who would get well on that theory, but I am sure that does not hold in these cases. -- ITEMS OF INTEREST.



Mercury Dental "Silver" Fillings:
The Debate Over Risk, Need For Replacement, and Detoxification

by Ronald R. Parks, M.D.


A review of studies on mercury toxicity and dental amalgam concludes that the animal and human experiments to date, demonstrate that the uptake, tissue distribution and excretion of amalgam mercury is significant and that dental amalgam is the major contributing source to the mercury body burden in humans.

Several scientific reports have suggested a possible relationship between certain chronic or unexplained illnesses and the presence of mercury in the body. It appears that toxic substances, such as mercury, may accumulate in the body and have the potential to damage the brain, heart, lungs, liver, kidney, blood cells, hormones and suppress the body's immune system. Some researchers are looking at the possibility that mercury toxicity may play a role in the development of multiple sclerosis, Parkinson's and Alzheimer's diseases. A human autopsy study comparing the brain tissue of people with Alzheimer's disease, with an aged matched group of brains from people without Alzheimer's Disease, showed the Alzheimer's group to have a significant higher concentration of mercury in all the areas of the brains involved in memory function (Wenstrup, D. Ehmann, W.D., & Markesbery, W.R., Brain Res. 1990, 533, 125-31). Mercury poisoning in people exposed to large amounts of industrial or environmental mercury has been studied. Its relationship to severe symptoms and illness has been well documented.

Now there is accumulative evidence that long term exposure and absorption of smaller amounts of mercury can result in some of the same symptoms and problems seen in individuals that have had significant exposure to mercury. Possible symptoms related to mercury are vast and include: neurologic and psychological problems, fine tremors (as in handwriting), depression, chronic fatigue, increased irritability, moodiness, nervousness, excitability, difficulties with concentrating, loss of memory, sleep difficulties, nausea, diarrhea, loss of appetite, birth defects in offspring, kidney disease, lung disease, swollen glands, tongue ulcerations, dark pigmentation in the gum, headaches, paralysis, numbness in arms, legs, hands and feet, poor resistance to infection, pain (especially facial pain), vertigo, ringing in the ears and many other symptoms. Improvement has occurred in some individuals after the removal of mercury and mercury detoxification. Improvements have been reported in kidney function, reversal of some mental and neurologic symptoms, thought and memory disturbances, chronic fatigue and the reversal of other symptoms as mentioned above, which have been thought to be due to chronic and untreatable illness.

The Source of Toxic Mercury

The sources of mercury contamination have been very controversial. However, a growing number of research scientists feel that a major source is the mercury found in dental amalgams, with lesser amounts from fish, seafood, other foods, contaminated water and air pollutants. For more than 150 years, dentistry has used silver mercury amalgam (commonly referred to as "silver" fillings), which contains approximately 50% mercury metal as the preferred tooth filling material. Medical research has demonstrated that this mercury can be released as a vapor into the mouth. It is then inhaled and absorbed into the body tissues where it eventually becomes tightly bound to cell protein. A review of studies on mercury toxicity and dental amalgam, by Lorscheider, Vimy and Summers, concludes that the animal and human experiments to date, demonstrate that the uptake, tissue distribution and excretion of amalgam mercury is significant and that dental amalgam is the major contributing source to the mercury body burden in humans (article: Lorscheider, et. al., "Mercury exposure from 'silver' tooth fillings: emerging evidence questions a traditional dental paradigm" FASEB J. 9, 504-508 1995). It has been felt that mercury in dental amalgam is safely bound. However, growing evidence again suggests that mercury can enter the body through the vapors. Chewing, grinding the teeth, hot food or drink and even the corrosive action by our saliva may cause these vapors to be released. Sheep exposed to mercury dental fillings, after 30 days of chewing, showed significant loss of kidney function (Boyd, N.D., et al. Am. J. Physiol.1991, 261, R1010-R1014). A 1992 study in Sweden showed a fecal excretion of total mercury to be a 100 times greater than the mean intake of total mercury from a normal diet in individuals with a large number of amalgam fillings (Skare I. and Engvist A. Amalgam restoration-p;an important source to human exposure of mercury and silver. Lakartidningen 15:1299-1301, 1992). A recent study released in the Journal of the American Dental Association, failed to show any significant relationship between the number and surface area of occlusal dental amalgams and cognitive performance. It, however, did suggest that mercury from dental amalgam surfaces may be absorbed and related to levels of urinary mercury. This study didn't answer the question of the potential toxicity of absorbed mercury to other organ systems or even to the brain when the special predisposing factors are present, whatever they might be, in those that develop Alzheimer's disease or other progressive degenerative diseases ("Dental Amalgam and Cognitive Functions in Older Women: Findings From the Nun Study," Saxe, Stanley, R., D.M.D., Journal of the American Dental Association, Nov. 1995;126:1495-1501).

Environmental protection agencies now recognize mercury as a hazardous substance and are trying to regulate the amount of airborne mercury in the workplace. Dentists aware of the toxic nature of mercury often use special procedures in disposing of mercury to avoid touching or breathing its vapors. Use of dental amalgam containing mercury is now being phased out or limited in several European countries such as Sweden and Germany. Also there is an effort by a growing number of dentists to develop and use non mercury containing materials for dental work and to use alternatives to mercury fillings.


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