Amalgam - 1881
"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.
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