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 {Rmrintedfrom (lie Canada Medical Journalj. Nooember^ 1870.) 
 
 THE U3E OF 
 
 AMALGAM OF MERCURY 
 
 AND OTHER. 
 
 f 
 
 METALS IN FILLING CARIOUS TEETH. 
 BY H. M. BOWKER, 
 
 Dentist, Montreal ; and Fellow of the American Academy 
 of Dental Science, Boston. 
 
 
 
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The use of Amalgam of Mercury and other Metals in fiUing Carioua 
 Teeth. By H. M. Bowkkr, Dentist, Montreal, and Fellow of ihe 
 American Academy of Dental Science, Boston. 
 
 In the January number of the Canada Medical Journal, an article of 
 mine appeared on the dangerous practice of filling teeth with amalgam. 
 I am impelled to write again on the subject to rebut statements and 
 comments which have appeared in other jonrnals. 
 
 First : — In the February number of the American J.ournal of Dental 
 Science, published at Baltimore, the editor copied my article in full, and^ 
 in his criticisms thereon, admits the general truth of my argument, but 
 thinks I have taken an extreme view, and believes that amalgam can be 
 safely used in teeth which are mere shells, but never iYi teeth which can 
 be saved, even with tinfoil. 
 
 Admitting, which I do not, that nothing but amalgam could save such 
 frail teeth, it would, in my opinion, be much better to have them ex- 
 tracted than incur the risk of permanently injuring the constitution by 
 the use of any kind of mercurial paste, but that is unnecessary ; as it has 
 been incontestably proved that a tooth which can be saved by such 
 " paste " can be saved by the use of gold or tin-foil, both innoououa 
 materials. In corroboration, the American Society of Dental Surgeons, 
 at their Convention, 1841, declared that there is no tooth affected by 
 earies in which gold-foil cannot be employed to render the organ ser- 
 viceable. Again, the American Journal of Dental Science has always, 
 in its articles on the subject, taken a most decided and uncompromising 
 stand against the use of amalgam for filling teeth, more especially during 
 the time it was conducted by such able men as C. A. Harris, A. 
 Westcott, W. H. Dewinell, S. Brown, Piggott, and E. Parmly, all of 
 whom repudiated the use of amalgam, and those of them now living 
 remain unchanged in their opinions on the question. 
 
 Mr. F. G. Callender, member of the Royal College of Dental Surgeons 
 and professor of Dentistry at the same College, admits that he has for a 
 long time past discarded the use of amalgam, unless in exceptional oases., 
 and he agrees in the main with me as to its unfitnesss, but he denies 
 that the College encourages its use. Mr. Chittenden, also a member of 
 the same College, says : — '''That the application of mercurial paste should 
 
 5S877 
 
be limited to tooth so frail, or not suflScicntly fixed in the socket to admit 
 of any but the gentlest handling." Is not this theory of limitation an 
 admitted recognition of the baneful effects of amalgam ? If for mechan- 
 ical considerations, amalgam may be used in one tooth, regardless of 
 consequences, why not iu another? There can be neither honesty nor 
 consistency in the use of a compound, which the operator believes to be 
 pernicious, for the sake of overcoming a mechanical diflSculty. Better by 
 far extraction of the tooth, than the absorption of poison into the system 
 A surgeon may as well, rather than sacrifice a limb, let the patient die 
 from gangrene and mortification. 
 
 In the face of these eminent American authorities, Mr. W. G. Boers, 
 co-editor of the Canada Dental Journal, not only defends the use of 
 amalgam, but has the hardihood to state that I am guilty of using a 
 compound which I condemn fts malpractice. To the latter assertion, I 
 conscientiously amrm that never in my twenty years practice have I used 
 mercurial paste. Mr. W. G. Beers, with the same regard for truth, 
 denies my assertion that the American Society of Dental Surgeons 
 unanimously, in 1845, carried a resolution condemnatory of the use of 
 amalgam. I think the following extracts from the proceedings of the 
 Society, dated New York, August 9, 1845, will be suflScient refutation 
 even for Mr. W. G. Beers. 
 
 Firstly, it is stated, " that the objects of this Society are the mutual 
 improvement of its members and the protection of themselves and the 
 public against the quackery and empiricisms which are the disgrace of 
 the profession." 
 
 " The Society does not presume in this communication to speak of more 
 than a single one of those base deceptions by which individuals calling 
 themselves dentists are imposing on the community. We allude to the 
 practice of filling decayed teeth with amalgam, known under the name 
 oi royal succedaneum, lithodion, mineral paste, admantine cement, ala- 
 baster cement, diamond cement, and other improper substances, by the 
 use of which thousands of valuable teeth are 'annually destroyed, and 
 innumerable evils result to the community at large which can never be 
 repaired." 
 
 " The Society has unanimously declared that the use of the above 
 named amalgams for stopping teeth is malpractice, destructive to the 
 safety of the teeth, injurious to the healthy condition of the mouth, and 
 not unfrcquently exciting and jtromoting bad effects on the constitution 
 frequently disposed to the injurious action of mercury, which inva- 
 riably constitutes an ingredient m all these compounds. Every member 
 of this Society who shall hereafter use this substance under any of these 
 
5 
 
 imposing and deceptive names, or under any other name, it, hy that act, 
 expelled/roni the institution." 
 
 By order of the Society, 
 
 E. Parmly, President.'^ 
 Amos Westcott, Recording Secretary. 
 
 Mr. VV. G. Boers has the additional temerity to say that the above 
 resolution was finally rescinded. In refutation of this otli( r irratuitous 
 statement, Mr. W. G. iJeers has only to look at page 71, Now Series of 
 the American Journal, and he will find these words : 
 
 " That it is now seven years since the Society unanimously resolved 
 that it regards the use of mineral j)<^ste for stopping carious tooth as 
 malpractice.^^ 
 
 " In 1841, with the like unanimity, it had declared that amalgams 
 were hurtful to the teeth and every part of the mouth, and that, gold 
 could be used in every case where any form of filling fairly promised 
 advantage, and at subsequent annual meetings it reiterated these senti- 
 ments, till finally, in 1845, it resolved upon the expulsion of non-confor- 
 mists, and in 1847 actually inflicted the penalty upon some of its 
 members. "f 
 
 " Dentistry now, like the practice of medicine, may safely trust its gene- 
 ral character to the common caution and prudence which legitimate res- 
 ponsibility ordinarily requires. While, therefore, we would intimate no 
 change of sentiment as to the subject-matter of the protest, believing, as 
 we do, the substitution of amalgam for gold to be malprncticr, but 
 would still most earnestly advise that total abstinence from the practice 
 which we have heretofore enforced." 
 
 Can language be stronger ? The use of amalgam is absolutoly and 
 unanimously condemned 1 So much for Mr. W. G. Beers. 
 
 The Virginian Society of Surgeon Dentists resolved: — " That tlio use 
 of all pastes and cements, of which mercury is apart, entirely unfit for 
 and highly objectionable as for filling carious teeth, and further, that the 
 use of them in dental practice is empirical and is hereby declared to be 
 
 MAIjrRAOTl«E."J 
 
 The Mississippi Valley Association of Dental Surgeons also re- 
 solved : — " That we consider the use of all mineral pastes in the plugging 
 
 • Vol. G, pare 82. Annericaa Journal of Dental Science. 
 
 t Vol. 1, page 71. 
 
 J Vol. 6, r»K« 157. A.JofD. S. 
 
6 
 
 of tlie teeth us uvprn/cssional and highh/ injurious, and that we will 
 neither use it nor countenance its use by others.* 
 
 I respectfully ask Mr. W. G. Beers— Are the physical conditions of 
 the human frame different in 1870 from what they were in 184-7 ? If the 
 malpractice of amalgam was determined in 1847, what circumstances 
 cm possibly make its use sound and good practice in 1870? Is the 
 Canadian College of Dental Surgeons prepared to say that the members 
 of their kindred colleges in the United States arc ignorant empirics ? 
 
 Here is another mis-statement made by Mr. W. G. Bt-ers. lie says : 
 " I am qualified to assure you that neither college nor societies have 
 onoc, directly or indirectly, discussed the subject " — incaning that of 
 amalgam. In the Canada Dental Journal, Vol. I., page 110, are to 
 be found questions put to the students on amalgam. Mr. W. G. Beers 
 labours hard to convince the public that neither the college nor the 
 dental societies encourage the use of amalgam, yet with a marvellous 
 consistency, he, being secretary of one of the dental societies and 
 co-editor of the Canadian Dental Journal, not only advocates but 
 vindicates the use of amalgam, and more, advertises it. His brother 
 editor, Mr. Chittenden of Hamilton, upon the principal that there are 
 two sides to every question, speaking of tin-foil, says : — "//ta# as a cheap 
 filling, it is ivjinitcl)/ 2'rc/<'rahle to amalgam, in that it leaves no sting 
 behind." 
 
 To discover a truth and separate it from a falsehood is surely an 
 occupation worthy of the best intellect and not at all unworthy 
 of the best heart, so Mr. W. G. Beers has exercised his intellect 
 to disprove my statements and to throw doubts upon my pro- 
 fessional practice. He gives an array of names who are advocates of 
 anv;l<_'i.ri. Are they practitioners of any high repute? The standard 
 "writers un dental surgery are all but unanimous in the condemnation of 
 the use of amalgam — " their names are legion." There is hardly any 
 ■necessity for giving them, they are so well known to every student in 
 dental surgery. 
 
 Dr. Evans of Paris, who has a world-wide reputation, and is con- 
 sidered the highest authority in dental surgery at the present time in 
 Europe, says : — 
 
 '' / cannot, however, refrain from stating it us my deliberate opinion 
 that all operations in which amalgams art employed are merely tempo- 
 rary in their nature, an I that any tooth that can he fdled in a proper 
 manner with gold can he Effectually and permanently saved only by this 
 
 ♦ Voi. 5, page 119. A.J. ofD. S. 
 f Vol. 10, page 132. A. J. ofD. S. 
 
The above opinion he published to the world after ha:ving announced 
 the discovery of a compound of mercury with otlier metals, exempt — as 
 he supposed — from all the objections of other amalgams. The learned 
 Doctor, after having patiently and faithfully tried his system and found 
 it malpractice, had the honesty and manliness to disavow iim^'lpams. 
 Dr. Townsend of Philadelphia, who ranked very high in his profession, 
 and the inventor of a nostrum called " Townsend's amalgam," finding 
 the use of it injurious, publicly recanted nearly every advantage ho 
 claimed for it. lie said that in cases where he most relied on it, and 
 •expected to find the best results, it cntirch) /ailed,'-^ 
 
 Professor Taft, of the Ohio College of Dental Surgery and the author 
 of a,work on "Operative Dentistry," which is admitted by all American 
 •dontists to bo the best work extant on the subject (1868) closes an , 
 article condemnatory of amalgam paste in these words: — 
 
 " So groat and so numerous arq the objections to this material that it 
 is but little used by reliable operators. Its adaptability is the main 
 prop on which are based the arguments in its favour : it is easily 
 applied, and consolidates with considerable hardness. It is affirmed also, 
 teeth which cannot bo saved with anything cl.sc may be filled with this 
 and made more valuable. This, however, is not true since the ctnploy- 
 ment of the adhisive property of gold ; which property renders this 
 metal equal in adaptability to amalgam." 
 
 Dr. Watt in his "Chemical Essays," (18G8), says :—" Amalgam 
 plugs are usually large, as none but quacks insert them into small 
 cavities. We have frequently seen two, three, or foar larae onep in the same 
 mouth ; and in one n;outh we saw sevintnn large and small. For illus- 
 tration, let us suppose a ctse in which eighty grains of amalgam cement 
 are inserted — this is not an extraordinary case. Four molars, with a 
 email plug each, would give the amount. The forty grains o" 
 mercury (even though inert in the metallic state, which is not proved, 
 however,) would make two drachms of the blue mass, or forty officinal 
 blue pills, or about fifty-four grains of corrosive sul'limate, or would yield 
 forty-seven grains of calomel, or nearly forty-two grains of black oxyd of 
 mercury. Now, no scientific man could be surprised at witnessing eon- 
 fititutional effects from the presence of such quantities of any one of 
 these drugf?. But the amalgam advocates may, and do object, that these 
 compounds are not liable to be form 3d in the mouth, but with the next 
 breath, they go on to lament the ' blackness,' ' discoloration,' ' colora- 
 tion,' &c., through all the changes, ascribing it all the while to o.ry- 
 
 • This nostrum is also advertised in the Canada Journal of Dental Science 
 
8 
 
 datioji, thus acknowlodgin<» that the last named condition almost 
 invariably results. And it is objected, too, that if formed at all, those 
 drugs are formed, and therefore introduced so slowly and "gradually that 
 they can produce no perceptible effects. But such objectors manifest 
 an ignorance of scientific truth hardly excusable iu this enliji;htened ago 
 of the profession. The slow and gradual introduction is the important 
 point to be considered. It is hero that the danger lies. When rapidly 
 introduced, the system is aroused and rebels, and much of the poison is 
 ejected. This slow introduction is nothing else than " nurturing up 
 wrath against the day of wrath,' as in the case of the man that wore 
 the metal in a leathern bag. * The poison could only pass inQiiitessi- 
 mally into the system ; yet in six years it did its work. And those who 
 wear amalgam plugs in their mouth for six years, and esiwcially for 
 ' fifteen years,' have no security that their fate will not be similar. 
 When we read of old practitioners, whose neighbours, as well as them- 
 selves, have all along been using amalgams, and who yet assert that they 
 have never seen a case of ptyalism or other constitutional disease arising 
 from their use, we must be excused if we look upon them " with con- 
 siderable doubt, as to the value of their judgment, or opinions as reliable 
 diagnosticians.'' 
 
 " One cannot believe that amalgam fillings can produce ptyalism, because ;, 
 this is produced through the general system whether the mercury is used . 
 externally or internally. Now it is not probable that any one believes 
 that amalgam plugs can produce ptyalism by mere local action." 
 
 " Another is a disbeliever because ' it is well known that mercury un- 
 combined is inert ' — whicli is merely an assertion — and because ' equally 
 so must it be when combined with silver or tin,' which is a mere assump- 
 tion. And he is further confirmed in his position from the fact that the 
 proto-chloride of mercury (calomel) and deuto-chloride of morcuiy (cor 
 rosive sublimate) are formed from sulphate of mercury and nmriate of- 
 soda, triturated and sublimated. As this process cannot be very well 
 carried on in the mouth, it is hardly supposable that they are elaborated 
 to any extent." 
 
 " Well, there is chemistry for you. Are we to infer that chlorine and 
 mercury can combine only under the circumstances here detailed ? 
 When it is objected to the use of amalgams that there is danger of mer- 
 curial poisonings, the answer is that abscess, exostosis, and necrosis occur 
 in mouths where no mercury is used, as if these were what is meant by 
 
 • Dr. Watt refers to a fatal case, attended with salivation, brought on by 
 •wearing a leathern bag containing a few drachms of liquid ntercurj. 
 
{constitutional effects of mercury. And where a genuine case of poison- 
 ing is presented, it is ref Trcd to some other cause than mercury, because 
 many cases of *' irritate I gums looking terribly enough has yielded to 
 proper constitutional and local treatment," as if irritated gums were all 
 the effect of ptyalisni, and at if acute ptyalism was not amenable to 
 treatment. Any scientiiic dentist would infer that there is greater danger 
 of mercurialization from this source when the fluids of the mouth arc 
 acid than when they are alkaline. If a case of ptyalism presented itself, 
 and the amalgam plugs wore allowed to remain, a part of the proper 
 treatment would bo to secure an alkaline state of the saliva. And he 
 would infer that the disease was most likely the result of either the 
 oxydation or chloiidation of mercury ; and as its compounds with sul- 
 phur arc far less poisonous than its oxyd.s or chlorides, and are nearly 
 insoluble, he would take such measures as would secure its sulphidation. 
 We make these remarks merely to remind the reader that even ptyalism 
 is amenable to proper constitutional treatment ; and hence, yielding to 
 treatment is no evidence that the disease is not ptyalism. If the corro- 
 sion of mercury is stopped for the time, the disease will usually exhaust 
 itself, and recovery will take place without direct treatment. Many 
 advocates of amalgam suggest that many of the cases taken for the bad 
 effects of mercury arc the result of " mechanical irritation " which 
 would have resulted just as soon from bad gold filling. Now every one 
 who understands the subject knows that mechanical irritation never did 
 and never will produce results very much like mercurial ptyalism." 
 
 " It is well known that ptyalism may be, and is produced by other 
 causes than mercury. This is what is called " spontaneous ptyalism," 
 and it is cordially admitted that in a large majority of cases in which 
 amalgams are fused, no observable constitutional effects result. But it 
 will not do on this account to deny the fact of mercurial poisoning by 
 amalgam plugs. The same warrant is afforded for the denial of mercu- 
 rialization from any source. In* a large majority of cases in which 
 mercurials arc administered, no poisoning is observable. Indeed, it 
 would be no more than consistent for some of our disbelieving brethren 
 to write an article to prove that both mercury and its compounds are 
 inert. They would be at no loss for arguments stronger than those they 
 are in the habit of using in ('liscussing the " amalgam question." Why, 
 a patient has taken over fifty drachms of calomel in less than so many 
 hours " without the least sensible effect I" Take the position, and 
 'tick to it, that calomel never produces ptyalism. And if it should occur 
 while the patient is taking the drug, be firm and consistent^ by claiming 
 that it was about to occur any way, and has resulted simply from 
 " mechanical irritation." 
 
Mr. W. G. Beers and the advocates of amalgam allude to an old com- 
 pound used years ago, as if mercury had not the same effect upon the 
 constitution now as it had years ago. They do not deny that there is 
 mercury in the improved compound of amalgam now used, nor do they 
 tell us in what the new improvement consists. We pause to know in 
 what way their amalgam is improved ? According to Dr. Watt, amal- 
 gams used to be made of mercury and silver ; their use has long since 
 become unpopular, and is regarded as a black spot on our professional 
 escutcheon. They are simply rendered respectable and perfect now by 
 the addition of another base metal. 
 
 Mr. W. Gr. Beers says : — " We might give up filling teeth altogether 
 if we were to abstain from every material that may be abused. With 
 equal propriety it might bo urged against gold that because when highly 
 oxydized it becomes a powerful medicinal agent, therefore it should not 
 be used for filling teeth." 
 
 The weakness of such an argument needs no pointing out, for the 
 objection to amalgam and the preference for gold are equally based on 
 special causes. As long as I have been a member of the professionj I 
 was not aware that pure gold would become highly oxydized when used 
 as plugs in the teeth, or would have any medicinal effe<^ on the constitu- 
 tion. 
 
 Gold is the best and most innocuous material that can be used for 
 filling teeth, and as such was never known to have any deleterious eiFect 
 upon the constitution. With mineral paste or amalgam how different I 
 There are some constitutions so susceptible to the action of mercury that 
 even one half-grain in a tooth will cause severe neuralgic pains, so that 
 however carefully manipulated and vastly improved the amalgam now 
 used may be, the effect is frequently such as to enforce the immediate 
 removal of the poisonous compound from the mouth, which being done, 
 all the unfavourable symptoms at once disappear. The difference is 
 obvious, in the use of gold the patient does not incur any risk of injur 
 of his constitution, whereas, in the case where amalgam is used he docs 
 incur that risk. Scarcely a week passes that I do not witness the evil 
 consequences resulting from the employment of an amalgam on the con- 
 stitution of patients, many of whom are willing i <^\\6 me their testi- 
 mony with regard to their sufferings and to the modx. and extent of their 
 relief. y-~ 
 
 Mr. W. G. Beers says : pAll amalgamists say the same, and I may 
 remark that they are only a repetition of the stale arguments of twenty 
 or thirty years since.*' H»^«kd «»y« A»^ " those who use amalgam for 
 front teeth, or for small cavities are quacks" — therefore, the inference to 
 
11 
 
 be drawn is, that those who use it by wholesale in large cavities are jus- 
 tified in so doing. Assuredly if it saves frail teeth with large cavities 
 without any detriment to the constitution, what would it not do in the 
 case of firm teeth with small cavities? Surely Mr. W. G. Beers 
 trifles with the intelligence of his readers when he says " the possibility 
 of amalgam being abused, is no more reasonable argument against its use 
 than an argument that no preparation of arsenic, morphine, &c., should 
 be used because they are iufallible poisons. If it were considered neces- 
 sary to administer arsenic, morphia, &o., it would be for the purpose of 
 arresting a serious malady, or for the preservation of life, but in the case 
 of the mercurial poisons the object would be to save a tooth ; therefore, 
 there is a difference in the two applications, the one saving life, the 
 other a tooth. . . 
 
 An operator who uses foil of any kind would soon manifest his lack of 
 skill by the sudden disappearance of the fillings, therefore his imposi- 
 tion on the public would be as short us the duration of his operations, at 
 the same time his incapacity would have no injurious effect upon the 
 health of his patient. The operator who uses amalgam has only to put 
 it in the cavity of the tooth in a plastic state, where it soon becomes 
 hard and remains in the cavity until decay takes place around the plug, 
 bat all the time it is there the patient has in his mouth a poison of slow, 
 steady, but certain malignity ; a poison, even in its insoluble combina- 
 tion, capable of producing grave and lasting disturbances of health. 
 
 What says Dr, Slack, Professor of Chemistry in the Medical College 
 of Ohio, about amalgam ? His answer is conclusive, he says : — *' The cellu- 
 lar tissue of the tooth is filled with minute arteries, veins, absorbents, 
 and nerves ; leaving out of view galvanic action, what must bo the effect 
 from the oxydation of the inserted amalgam ? Will not the deleterious 
 vile compound be absorbed ? Can such a substance certainly be of any 
 advantage to nerve, artery, veins, blood, &c. ? The poison will be thrown 
 into circulation, and though it may move slowly at first, it will, unless 
 arrested, certainly perform its work of destruction. Health must be 
 prostrated and an early gravu will be the portion o^thc victim."* 
 
 Dr. Westcott, an authority, — ho having filled the Professorial Chairs 
 of Operative and Mechanical Dentistry, in the Dental Colleges of Balti- 
 more and New York — is one of the original and most indefatigable 
 writers against all preparations of mercury for filling teeth. What does he 
 say ? His utterances are not uncertain. What language can be more 
 decisive? He, in the iroct '?mphpti(;ipanney,s'iys: — "Np man who has 
 
 • Page 63, Vol. 6. ^ . J. of D S. 
 
 * • " I - J » 
 
12 
 
 so little self respect as to use this amalgam to any considerable extent, 
 will refuse to stoop to any species of quackery which will contribute to 
 his pocket. . . . As we weaken public confidence in this deception 
 and enlighten the public mind respecting it, we not only blot out this 
 particular species of quackery, but to a corresponding extent weaken the 
 power of those charlatans to practice this or any other deceit by pointing 
 to them as the men who have, at least in one way, imposed upon the 
 community and filled their teeth with no other motive than filling their 
 own pockets, and without any regard to the consequences."f *'■ *•' i. 
 
 Feeling so strongly as I do on the subject, and having been wantonly 
 assailed for my first communication against the dangerous practice of 
 filling teeth with amalgam, T cannot refrain from making another quo- 
 tation, and it shall be the last. It is from the valedictory address of 
 Dr. Parmly, of New York, delivered to the graduates of the Baltimore 
 College of Dental Surgery. The Doctor says: — "A distinguished 
 
 Parisian, a gentleman and scholar. Count de D , now in New York, 
 
 remarked to me a few days ago that he had discovered during his resi- 
 dence in this country that there are two classes of dentists, one very high, 
 the other very low, and that the latter live upon the reputation of the 
 former — the latter chiefly consist of ' amalgamists.' There may be 
 honest and truthful men among them, but if there be, they differ very 
 much from those champions of amalgam whom I have encountered and 
 already proved to be without either professional or moral honesty. I can 
 bring the same proof with regard to others if necessity shall require it. 
 I am willing, however, that this necessity shall never call me to the un- 
 pleasant task, but I will not shrink from the task when the conduct of 
 knaves and charlatans shall render that task a duty. .. I '' . ' 
 
 •' To the American public I owe many obligations for the confidence my 
 fellow-citizens have reposed in my professional practice, and I intend to 
 discharge at least a part of my obligations by exposing the tricks of 
 mountebanks and the impudence of knaves. Of all the quackeries of 
 our profession, or of those who live only to disgrace it, I regard mercu- 
 rial paste most notorious, execrable, and base, as used in this country, 
 and should a part of my life be spent in exposing the evils of such nos- 
 trums, I shall not regard it as utterly lost to my race, nor to my 
 country."* 
 
 • Page 178, Vol. 8. A. J. of D. S. 
 
 i OgD i lU, Y Ul. o. XI. O. Ul U. O. 
 
 t Vol. 1, New Scries, ra^e'-Ser}.' *:•;••. | •: t^*\ :',: