IMAGE EVALUATION TEST TARGET (MT-S) 4 ^ // o ^ .^4i.. ?»W /. & % 1.0 t^ 1^ ii 1.25 M. 11.6 Hiotographic Sciences Corporation A :i>^ ^ ^1 V ^\ <^ 1^ 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 873-4503 ^ CIHM/ICMH Microfiche Series. CIHIVI/ICMH Collection de microfiches. Canadian Institute for Historical l\^icroreproductions / Institut Canadian de microreproductions historiques Technical and Bibliographic Not^v/Notes techniques et bibliographiques The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method r* filming, are checked below. L'Institut a microfilm^ le meilleur exemplaire qu'il lui a 6t6 possible de se procurer. Les details de cet exemplaire qui sont peut-dtre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite, ou qui peuvent exiger une modification dans la m6thode normale de filmage sont indiqu6s ci-dessous. ["""/^Coloured covers/ UlI Couverture de couleur □ Coloured pages/ Pages de couleur □ Covers damaged/ Couverture endommagee □ Covers restored and/or laminated/ Couverture restaurde et/ou pelliculde D Cover title missing/ Le titre de couverture manque D Pages damaged/ Pages endommagdes □ Pages restored and/or laminated/ Pages restaurdes et/ou pnllicul6es I "l/^ages discoloured, stained or foxed/ I ^ Pages d6coior6es, tachetdes ou piqudes D Coloured maps/ Cartes g6ographiques en couleur Coloured ink (i.e. other than blue or black)/ Encre de couleu; (i.e. autre que bleue ou noire) □ Pages detached/ Pages d6tach6es r~7|^ Showthrough/ I I Transparence Coloured plates and/or illustrations/ Planches et/ou illustrations en couleur Bound with other material/ Relid avec d'autres documents I I Quality of print varies/ Qualitd indgale de {'impression Includes supplementary material/ Comprend du materiel supplementaire D □ Tight binding may caure shadows or distortion along interior margin/ La reliure serree peut causer de I'ombre ou de la distortion le long de la marge intdrieure Blank leaves added during restoration may appear within the text. Whenever possible, these have been omitted from filming/ li se peut que certaines pages blanches ajouties lors d'une restauration apparaissent dans le texte, mais, lorsque cela itait possible, ces pages n'ont pas 6t6 filmdes. □ Only edition available/ Seule Edition disponible Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partiellement obscurcies par un feuillet d'errata, une pelure, etc., ont 6t6 filmdes d nouveau de fapon d obtenir la meilleure image possible. D Additional comments:/ Commentaires suppl^mentaires: This item is filmed at the reduction ratio checked below/ Ce document est filmd au taux de reduction indiqu6 ci-dessous. 10X 14X 18X 22X 26X 30X J .. 12X 16X 20X 24X 28X 32X The copy filmed here has been reproduced thanks to the generosity of: National Library of Canada L'exemplaire film6 fut reproduit grdce d la g6ndrosit6 de: Bibliothdque nationale du Canada The images appearing here are the best quality possible considering the condition and legibility of the original copy and in keeping with the filming contract specifications. Les images suivantes ont 6x6 reproduites avec le plus grand soin, compte tenu de la condition et de la nettetd de I'exemplaire filmd, et en conformity avec les conditions du contrat de filmage. Original copies in printed paper covers are filmed beginning with the front cover and ending on th"* last page with a printed or illustrated impres- s. > or the back cover wherv appropriate. All otl.&< original copies are filmed beginning on the first page with a printed or illustrated impres- sion, and ending on the last page with a printed or illustrated impression. Les exemplaires originaux dont la couverture en papier est imprimde sont filmds en commenpant par le premier plat et en terminant soit par la dernidre page qui comporte une empreinte d'impression ou d'illustration, soit par le second plat, so'on le cas. Tous les autres exemplaires originaux sont film6s en commenpant par la premidre page qui comporte une empreinte d'impression ou d'illustration et en terminant par la dernidre page qui comporte une telle empreinte. The last recorded frame on each microfiche shall contain the symbol -^ (meaning "CON- TINUED "), or the symbol V (meaning "END "), whichever applies. Un des symtoles suivants apparaitra sur !a dernidre image de cheque microfiche, selon le cas: le symbole —^ signifie 'A SUIVRE", le symbole V signifie "FIN". Maps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginninp in the upper left hand corner, left to right an J top to bottom, as many frames as require J The following diagrams illustrate the method: Les cartes, planches, tableaux, etc., peuvent dtre filmds d des taux de reduction diffdrents. Lorsque le document est trop grand pour dtre laproduit en un seul clichd, il est filmd d partir de Tangle supdrieur gauche, de gauche d droite, et de haut en bas, en prenant le nombre d'images ndcessaire. Les diagrammes suivants illustrent la mdthode. 1 2 3 1 2 3 4 5 6 'J ' /-\^S*w ."tx^^ /-\ *mi y^ft^ .- 3 .0t)JJ^e)Qt!)£)t)-0'g)-Qgl^O£ ' Q£)^.QCi g r TH^ DISCRIMINATE USE OF ^M^LGIA.M FOR FILLING TEETH BY W. GEORGE BEERS, L. D. S. SURGEON DENTIST, RK 544 B4 Potttreat : NTED BY JOHN LOVBLL, St. NICHOLAS STREKT. 1871. % a 1} n i i) a ^ '[I 3^f^O'^ 11?*^ ■•-""'• •■ CANADA NATIONAL LIBRARY BI6LIOTHEQUE NATIONALE ) TBI DISCRIMINATE USE OF A.MJS.T.GrA.M. 1>0S FILLING TEETH, BY W. GEORGE BEERS, :.. D. S. SURGEOIf DEMTI9T. PRINTED BY JOHN LOVELL, St. NICHOLAS STREET. 1871. About a year ago, Mr. H. M. Bowkcr published an article on the use of amalgam for filling teeth, in which he asserted: 1. " That whoe-nr used ^Amalgam' was unskilful, ignorant and dishonest." 2. " That the ' Royal College of Dental Surgeons of Ontario,' and the 'Dental Association of Quebec,' (Province), advocated and encouraged its use ; and that nearly all the Dentists in Canada advocated its use." 3. " That he did not use it." This method of advertising one's self is not at all rare ; but the effort to depreciate the Dental Institutions of the Dominion, and the private practice of one's competi- tors, has, I am happy to say, had its origin in Cuuad". in this first literary attemi-t of Mr. Bowkers'. In replying to Mr. B.'s first article, quotations were given from the leading prac- titioners of the day in Europe and America, favoring the proper use of amalgam. The accompanying article was written to refute personal and other assertions in his second article. The fact that amalgam was once virulently opposed, even by leading men, U poor argument against its use now. How much of the dental practice of the present day, like much of medicine and surgery, was sneered at as visionary twenty years ago I AMALGAM FOR FILLING THKTH. BV W. OEO. BEIiBB, L.D.8., HOflTBEAL. FROM THE CANADA JOURNAL OF DENTAL SCIENCE. The revival of the venerable views on amalgam, and the specious but fallacious arguments adduced again,', it, which any one can read almost verbatim in old numbers of the Amcrica7i Journal of Dental Science, is to me like turning over the leaves of a dusty folio, which has been laid aside for half a century, and finding between two of the pages a dead, dry fly — a veritable blue-bottle. Mr. Bowker " rings out the same old changes," and harps on the same effete strain as did his dogmatic masters of thirty years ago. To the dental profession the question is a trite and worn-out theme. Common sense and superior intelligence have almost unanimously ignored the prejudiced tirade against amalgam 2>cr se ; dispassionate investigation and discussion have removed the unreasonable opposition to i^s discriminate use, except from the n 'nds of one solitary individual in Ca.iada, and a " corporal's guard" in the United States : and it must I ^ remembered tliat there are always a few men in every profession, who assume a superior intelligence to the rest of their col- leagues, but whose professional history, with rare exceptions, does not generally present any proofs of their great superiority, other than what they themselves assume. Thirty years ago there were probably two hun- dred dead opponents of amalgam, when there were not over 1,000 dentists on the continent, and they poorly educated ; to-day, though there arc pro- bably 30,000 dentists — hundreds of them having had the benefit of colle- giate education — yet there is only one in Canada, and a few in the States, who hold the extreme views expressed in Mr. B's. article. Mr. B., would therefore, have us infer that the dental profession has actually retrograded ; that the intelligence of those who recanted their old views is not so great to-day as it was thirty years ago ; that thirty years' college and associa- tive reform has done nothing for its intelligence! It would occupy an entire number of the Journal to give even a bare epitome of the bitter " Amalgam Controversy" of 1842-45, the vulgar personalities it engen- dered, the defamation it produced — which Mr. B. seems to hayj imitated in regard to our Canadian Dental Societies — and the injurious tendency of the affair on the progress of the dental profession. To le-discuss the whole subject of amalgam would, 1 am aure, be an unneces- sary concession to an opponent who cannot offer one original argument, and who has to resort to arguments which have lonj^ ago been refuted, and which the enlightenment of the profession utterly ignores. However, I have no objections to lay bare a few of Mr. B's misstatements, an>l I beg a careful reading from even the most prejudiced. I was prepared for the array of quotations from the minutes of defunct societies, old dental periodicals, et cetera, to which my opponent is at lant reduced, and which he now submits as fresh testimony (!) agniust the use of amalgam. I will take it for granted that Mr. B. has never used amalgam, as it will more conveniently allow me to dispose of his arguments. His dernier resort is precisely what I wanted, to show that not only has he made rash statements in reference to the views still held by some of the strong anti-amalgamitcs of 1845, but that his views of amalgam hav : not kept pace with the dispassionate investigation and intelligence of the times, which has led almost all of the old opponents who are living to so modify their practice as to use the filling. I freely confess to a great want of respect for old authorities in den- tistry, and should be as much disposed to regulate my practice by what was gospel in 1845, as to follow the vagaries of Celsus, or pin faith to the chemical speculations of the 16th century. My opponent appeals with deference to old writers, who enunciated principles and practices when the science of dentistry was at its dawn, and much of whose asser- tions are mere theory, easily disproved by first year students, and who are more cherished for what they did in smoothening the way to progress than for any positive authority they now possess. And yet we do find dentists in praatice who continue to destroy all exposed pulps ; to extract all teeth afiFected with chronic periodontitis ; to treat hyper-sensitiveness of dentine with arsenic; to cram arsenic around the neck of roots of teeth, in order to cause absorption of the alveolus, previous to attempting their extraction ; to use the old key of Garengeot almost exclusively ; and to follow many other antediluvian principles, simply because Harris or Mrs. Grundy so advised, and because they have not the independance to think for themselves, or the liberality to concede to others who differ with them the barest possibility of being in the right. They make dentistry a science of speculations rather than a science of facts, and are as tenacious, not only of their views on amal- gam, but on every other dental question, as if there was concentrated in their brains an incarnation of sagacity, equal to that of the seven sages of Greece stewed down together in iEson's chaldron. The one distilled drop of otto of roses from a million blossoms is not a circumstance to them. Ab I showed in my first article, Dr. Parmly used precisely the same arguments thirty years ago as Mr. B. endeavoured to startle the read- ers of the C. M. J. with as original, and neither Mr.B. nor any one else has ever been able to add one whit ; excepting the proportions of amalgam as given by my opponent— 04 parts of mercury to 36 of silver— which are, I will admit, " purely original : his figures, however, remind me of the story of the weaver, who added the year of our Lord at the top of his page to the amount of his profits, and who got astray in the small itemofof $18G0. On the 19th July, 1842, Dr. Pahmly wrote: "I vnce prepared some amalgam, and filled a dead tooth with it for Mr. N., of New York, and he is the only person in the world that can exhibit a tooth ever touched by me with it ; having proved its deleterious oflFects I uniformly condemn it, and have condemned it for many years." Now here the great anti-amalgamitc exposes a specimen of the scientific rea- soning indulged in on amalgam. Ho admits he only used it once, and in a dead tooth, (and yet saved that tooth,) and then, with characteristic logic, concludes that he proved its deleterious effects from more theory and this one case. Mr. Bowker, however, does not need even to test the material for himself He has the op' lions of authors, such as Harris and PloaoTT, who participated in the amalgam war of 1842, and who cannot conveniently recant, because they are dead ; the opinions of Dr. Parmly, who has not been in the practice of dentistry for over twelve years, and who does not now presume to offer himself as an. authority ; he has old volumes of the American Journal of Dental Science, which are as dear to him as the Koran to the Mahometan ; he has resolutions against amalgam of old societies passed during the Amalgam war, which certainly cannot repeal them, because the constant bickering ruined their usefulness, and they have been defunct for two decades ; he has old opinions of eminent dentists; but the peculiarity about it is that the American Journal of Dental Science of to-day rejeccs the dictum of the American Journal of Dental Science of 1842, and the eminent dentists whom Mr. B. quotes as having said such hard things against amalgam in 1842, have recanted those hard words, and now use " the poison !" — " So much for" Mr. H. M. Bowker. I must reiterate the regret expressed in my first aifticle, that my oppo- nent found it necessary in relieving his mind of his opinions on a scien- tific question, to impute "ignorance, want of skill, and dishonesty," pointedly to our Canadian Dental Associations, and to all who were not exactly of his opinion ; and to assert, with that innate modesty which characterizes great men, that as all the dentists in Canada, except himself, used amalgam, therefore he was the only skilful and honest one 6 loft in the Dominion ! With such contributions to the polite literature of the dental profession I shall not attempt to compete. But this assertion compels me again to remove the impression his articles were intended to convey, viz. ; that amalgam is par excellence used indiscriminately by those who use it at all, and that those «vho use it with discrimination are equivalent to those who use nothing else. lie also endeavours, in true 1842 fashion, to make his readers believe, that because I defend the use of amalgam at all, I defend its exclusive use by quacks. Very gentlemanly, indeed. Every honest dentist accepts the very simple proposition, which is not at all original with Mr. B., but was made and accepted before ho was born, or dentistry was a regular profession — that gold is decidedly the best material for the teeth in every case where it can be used. I mean used so as to preserve the tooth and not so as to fall out in a few weeks or even years ; used so that the fact of gold being in the tooth is unmistakable, while the fact that the decay has not been half removed or the filling not properly conden.sed against the parieties of the cavity, is unmistakable too. It is rather trite to present the fact that the principle of every honest dentist — assuming that the public really believe there are other honest dentists in Canada besides my modest op- ponent — is to use gold for filling teeth as much as possible ; and also that the principle of those who use amalgam, is to use it mostly in teeth which my opponent admits he would extract. Mr. B. extols, tin-foil in lieu of gold, and docs not seem to think that galvanic action can be excited in the mouth with gold and tin as well as with gold and silver ! I never yet saw a tooth that could be well .filled with tin, but that could be better filled with gold. I have seen fill- ings of tin quite as discoloured as bad unclcansed amalgams. Circum- stances occur where a soft filling is an absolute necessity, unless the tooth is extracted. The principal consideration in favor of tin over gold is the one Mr. B. seems to despise in »malgara, viz., cheapness. There is no medicinal virtue in gold-foil. To be of use at all it must be thoroughly consolidated, and classes and conditions of decayed teeth exist which are too frail to bear this requisite consolidation, and yet which with a filling easily introduced can be made useful for mastication for lifo. Now, no honest dentist would use amalgam in a front tooth, for the simple reason that a front tooth is more exposed ; and the most precious, most orthodox filling is demanded. Amalgam in some mouths will discolour on thesui*- face but in the large majority of cases where a good amalgam is properly inserted, it does not discolour. It is more liable to discolour in approximal cavities, because the tooth-brush cannot reach these jjoints. However^ several of the preparations of gold, Buch as rponge gold, &c., much used by some dentists, will become as black as ink on the surface. Under no circumstances would I prefer to insert tin-foil in a front tooth ; gold can be just as easily inserted in every case. The opponents of amalgam meet with frail cavities which they cannot fill with either gold or tin-foil, and they either extract the tooth or fill it with a preparation of gutta pcrcha and silex ; or another compound called oxy-chloride of zinc, — a preparation of refined borax, quartz, French white zinc, which is calcined ; and to the frit formed, calcined zinc is added, and the laixture made by forming a paste with a solution of dry salt, chloride zinc and water. Neither of these can make permanent fillings, and I have seen many cases where teeth were plastered up with these destructible articles, and deluded the patient into the belief that they were securely filled, when the edges were breaking away, decay creeping in, and destruction ensured, where good amalgam would have saved them. Take very large cavities in the molars ; the labial and pos- terior sides broken away. To fill these properly with gold would necessi- tate an expenditure of time and material which few people in Canada, at present, appreciate sufficiently to pay for. And here I would say that in one family of four children, in Montreal, well known to Mr. B., I inserted 56fillings- none amalgam,— all of which, with the exception of 8, had been filled with gold, and oxy-chloride of zinc, by an anti-amalgamite who con- siders himself something superior, about two years before they came into my handf). In the teeth of one young man, well known to Mr. B., I re- placed 10 gold fillings which had been inserted by the same dentist as thfi above case, about eighteen months before. Now, if a dentist inserts such gold fillings, and charges the highest price, surely he had better have let ^hcm alone, and surely amalgam would be better for Mm, at least, to use. There are a class of dentists who have a class of custom among the poor. If they fill the teeth of the poor with any other soft filling than amalgam, they deceive the patient as to the permanency of the filling ; if thfiy use gold or tin exclusively, neither the cost of 'he former nor the labor of either can be remunerated. And what then ? Either the dentist must starve, or the teeth of the poor must be consigned to Mr. B's. scientific way of escaping an impediment, viz., extraction. I wish emphatically to remark, that I do not and did not defend amal- gam In toto. There is nut an honest dentist in the land but denounces its indiscriminate use, and will vcjniee when snine noii-iiiet;illic sift filling as good can be discovered to replace it. I perfectly agree that there is too much used, just as most of pliysicians aurce that there is too much medicine useil. lint thfre are poca'ly (pialififd dentists as well as 8 physicians, and you cannot regulate tlie practice of either in the respec- tive particulars. The abuse of a medicine is no argument at all for its abolition, or wha*^^ would be left of the pharmacopoeia ? Our Canadian dental societies were organized for the express purpose of elevating poorly qualified dentists to the highest standard they are capable of attaining, but Nr. B. consistently ignores their usefulness and defames their reputation lu Cch Canada Medical Journal. Can he divine a better way to chanf^., any u'alpractice or mistaken practice than by giving them gratuitous instruction and clinical education ? Any den- tist can show from the work of ** cheap dentists " and some who esteem themselves superior, such abominable specimens of gold fillings as to lead many to condemn gold for filling. Mr. B. is satisfied to look at the bad operations or failures of others with amalgam. Has he no perception for the like in gold ? and do all gold fillings preserve the teeth ? This dodge of classing those who use amalgam occasionally, with those who use it exclusively is worn out. A question arises here which it may be as well to dispose of. Can Mr. B.J be so ignorant of the proportions of amalgam as to believe what ho absurdly asserted in his first article — "When the mixture is subjected to the highest pressure in order to remove the free mercury, the amalgam then contains a preparation of 64 parts of mercury to 36 parts of silver?" What physician believing such to be the case, but would con- demn amalgam, as it would never harden in the tooth, and would certainly be swallowed. If Mr. B. is not ignorant of the absurdity of these figures, what were his motives in publishing such a statement, associated as it was with the other assertion that nearly all the dentists in the Dominion except himself, used it? I -jonsider it my businessasadentisttoregard the preservation of even a single tooth, in the most of cases, as highly as a physician would a human life. The very end and essence, the summnm bonum of the honest den dist is to save the human teeth, and conservative dentistry is far above the mere mechanical. Any quack may extract a tooth ; every one cannot fill it, even with amalgam, so as to preserve it. Mr. B. admits with bucolic innocence, that there are teeth which cannot be filled permanently with anything he now uses in his practice, — for it is a fact that other soft fillings than amalgam are not permanent — and that rather than fill a tooth with amalgam he would extract it ! There is dental science for you with a vengeance I And from " the expositor of the abuses of dent- istry " too ! Now according to this scientific admission, my opponent must have extracted hundreds of teeth, because he would not use amalgam, when thousands of proofs exist everywhere in this very city, and many 9 proofs in the teeth of physicisins and their families of Montreal, that amalgam has healthily preserved teeth from further decay, which would have been consigned to Mr. B's. forceps. Like nearly all opponents of amalgam, he presumes to speak ex cathedra on a point of practice which he "conscientiously affirms" he has never tried ! He offers his theoretical knowledge against the practical experience of the thousands of other dentists who are teachers in colleges, eminent operators, leading writers of the present day, not of 1 842 ; many of whom are also medical graduates, and who are the acknowledged head of the profession in America and Europe. I should like my opponent to explain the qualifications he possesses to justify him in this assumption. Is he not like the critics who judge a book from the title page, and who, be it marked, are invariably the nvjst dogmatic and intolerant critics of all ? Which testimony in the use of a medicine would be most worthy of con- fidence, — that of the comparatively obscure man who avows his opinions to be due to second- hand text books, back numbers of old periodicals, old opinions of writers, which they recanted, and resolutions of defunct societies, or that of the men who have the lead in every progressive dental movement, who are the acknowledged leaders in this most pro- gressive period of dentistry, who, with one or two exceptions, repudiate the assertions of the former ? Mr. B. would positively have the world believe that mere opinions formed thirty years ago are more reliable than as many years practical observation and experience ! There are points and paragraphs in Mr B.'s last article which I cannot quietly pass over — they are too tempting to omit. He labor?: liard for arguments, and gives as his reason for accusing the " Royal College of Dental Surgeons of Ontario " of encouraging the use of amalgam, that " in the Canada Journal of Dental Science," vol. 1. page 210, are to be found questions put to the students on amalgam, in the said College. The wrong use of the plural instead of the singular number does not seem to rub against the grain of his conscience whenever it can make an argu- ment appear stronger. There were not " questions " asked. There was only the one question asked. '• What is an amalgam," and this not by the exarairor on Operative Dentistry whose office is to " encourage" the proper materials for filling teeth, but by the examiner on Chemistry, whose office is to treat his questions from a purely chemical point of view But what has he to say about his false charge against the Dental Association of this province ? Nothing more than that as I was Secretary of the Association at the time, and because I edited the Dental Journal, therefore the Society of which I was Secretary" advocated and vindi- cated the use of amalgam !" Very logical, indeed. Very original logic. 10 Peculiar to Mr. H. M. B. And yet, Mr. B. conveniently overlooks the important fact that the only reason I wrote on amalgam was to disprove his false accusations, and that he hadpublished the false accusations in the Canada Medical Journal before I wrote a line on the subject, " So much for" Mr. H. M. B. How monotonous it is for some men to tell the truth f He also says "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," and yet in the second paragraph of his article, he says that the present editor of the Journal "thinks I have taken an extreme view, and believes that amalgam can be mfely used in teeth which are mere shells." He mentions Harris, Westcott, Dwin- ELLE, S. Brown, Pigqott and Parmly, all of whom he says, " repudia- ted the use of amalgam, and those 0/ them now living remain unchanged in their opinions on this question." We 1, Harris, Brown and Piogott are dead; Pwinelle refuses to discuss the subject; Parmly is no longer in practice, and Westcott, who is still a leading man in dentistry and who was actually the brightest man of them all, has recanted his old opinions. The ^'American Journal of Dental Science " in reviewing Mr. B's. first article said as follows : " This article is somewhat severe upon the " Royal College of Dental Surgeons," and the Dental Societies of Canada. Who Mr. BowJcer is ice do not know ; perhaps the " Canada Journal of Dental Science " can enlighten us ; but whether Mr. B. is qualified by professional experience and vanrsflgation to make a report upon this subject or not, much that he says is true, but at the same time we think that he has taken an ex- treme view of the case. ''Although no advocate for tliu iiiui!3v.riminate use of amalgam and believing that tin-foil is much superior as a cheap material for filling teeth, yet we think this compound may be used in teeth which are mere shells, so far gone that no other metal can be safely introduced, and that it will preserve such teeth for a time afc least, especially where their extraction is contra-indicated for some good reason. " On the other hand such fillings should never be used in teeth which it is possible to fill with either gold or tin-foil ; and in no case should amalgam be used in front teeth, or in the pulp cavities of teeth, or in the proximity of a living pulp. "When properly prepared and properly introduced, instead of amalgam fillings containing 64 parts of mercury to 36 of silver, as Mr. B. asserts, the proportion of mercury need not and should not bo half so great. The objections urged against this compound in Mr. B's. article would certainly hold good, if the amalgam used at th% present time was as im- 11 pure as that employed ten or twelve years ago. But a great ipiprove- ment has been made not alone as regards the parity of the ingredients composing amalgam, but also as to the manner of preparing and introdu- cing it into the teeth. " The following is the best method for using this material in cases where its use is indicated." TIk.i follows tlio detailed description of the " method of use. Now I ask any one of common sense if that is the uncompromising condenmatiou " of amalgam Mr. B. would make his readers believe the American Journal of Dental Science still main- tains. This extract is from the pen of the present editor of the A. J. D. S., — Prof. GoRGAS, who is also Vrofessor of Dental Surgery and Dean of the oldest Dental College in the world, that of Baltimore. Knowing ^ Mr. Bowker's high appreciation of the A. J. D. S., and all connected with it, I wrote to Prof. Goroas and received the following answers to questions, Dec. 2, 1870. Question — Do you not believe that amalgam will preserve a healthy tooth?" Answer (by Professor GoRQAS.) — " I do, if it is properly inserted into a properly prepared cavity." Question. — " Do you think it better to extract a tooth, as Mr, Bowker says he would do, rather than fill it with ainalgaiu." ^4.».swcr (by Professor GoRGAS.) — "I should prefer having a tooth tilled with amalgam, to having it extracted, and would so advise my patients."— " So much for" Mr. H. M. Bowicer. Dr. Westcott's writings and sayings seem to have great weight with Mr. B., who s.iys, " Dr. Westcott, nn authority — he having tilled the Professorial Chairs of Operative and Mechanical Dentistry, in the Dental Colleges of Baltimore and New York — is one o{ the original and most indefatigable writers against all preparations of mercury for tilling teeth. What does he say ? His utterances are not uncertain; what lan- guage can be more dicisive? He, in the most emphatic manner, says, " No man who has so little self-respect aa to use this amalgam to any considerahle extent will refuse to stoop to any species of quackery which will contribute to his pockets," &c. Precisely so say I; and every honest dentist joins in condemnation of the men who use amalgam to such a considerable extent as to seldom use anything else. Dr. Westcott was once an editor of the A. J. D. S. He is a great authority on amalgam, Mr. B. tells us, and the latter quotes what he said twenty-tive years ago ; a quarter of a century does not enlighten one according to Mr. B.'s theory. I trust, however, hia weak nerves will survive the 12 following little shock, and that Dr. Westoott will continue to hold a placo in his memory, Mr. B.'s "authority," like all sensible aa'l unprejudiced men, has the manliness to acknowledge his erroneous views on amalgam, and is now using " the poison." He was the Secretary of the " American Society of Dental Surgeons," which passed the resolution against amalgam, and his name is appended to that resolution with Dr. Parmly's ; and so zealous a seconder Avas he of the bitterness of the latter that he was named his "•fubis Achates.'' ^^ Syracuse, Jan. 16, 1871. Mr. W. Geo. Beers — Dear Sir, I am in receipt of your letter upon the sub- ject of the use of amalgam. I would have replied more promptly could ^ have found time to write you as fully as the subject demanded; for having somewhat modi/ted my views and nractice within the last fifteen or twenty years upon the subject, I hardly liked to give you the views I now entertain without giving you fully my reasons for such modification, and the restraints and limits I still hold in re reuoeto tbeir employment. Should I get time to do so, I will at some ''uture time write out my views fully upon this subject, stating when, ' only when, how, and only how, I use amalgam for filling a tooth. Very truly yours, A. WESTCOTT. May I not return the salutation of my opponent, and say "So much for"— Mr. H. M. Bowker, In another place ray opponent says, two leading Ontario dentists — one the co-editor of the G. J. D. S. — " agree in the main with me as to the use of A." Well, it seems necessary to reiterate that every honest den- tist agrees that the indiscriminate use of amalgam is wrong, and that the use of Mr. Bowker's amalgam proportions is not only wrong, but worse. But how hard up my opponent must be for arguments, when he has to quote such a statement of dentists V}ho actually use amalgam. He courteously says, I do not tell the truth in saying that the "American Society of Dental Surgeons" did "ot unanimously carry the resolution of 1845 condemning amalgc»m. The facts are these (my readers can interpret them as they please) : sixty-one members voted dead against the resolution when it was first brought up, and after these sixty-one had either resigned, or were expelled for non-compliance with the rash and silly movement, the remainder then " unanimously" (I) carried their own resolution. Mr. B. also denies that this resolution was finally rescinded : here is my authority for saying that it was. At a special meeting of the Society, held in Baltimore, 25th March, 1850, Drs. Westoott, Townsend, and I. H. Foster were appointsd a Committee to report on the propriety of rescinding the amalgam pledg:' At Sara- toga, in August, 1850 (the following appears in the New York Dental Recorder, vol. 5, page 69) : " The Committee appointed ?t the called meet- ing in Baltimore to consider the propriety of rescinding the amalgam pledge, reported through their chairman, Dr. E. Townsend, which report, after considerable discussion and recommittal for the purpose of amendment, was finally adopted, and the following resolution along with it:— " Resolved — That the several resolutions adopted by the " Society of Dental Surgeons," at the annual meetings held 1845-4G, having the effect of enforcing subscription to the protest and pledge against the use of amalgams and mineral paste fillings for teeth, be, and the same arc, hereby rescinded and repealed." Common sense has also repealed it : science peremptorily repeals such rubbish in her onward march. Mr. B. cites resolutions passed in the dark ages of dentistry by the "Virginian Society of Surgeon Dentists" and the " Mississippi Vahey Association of Dental Surg3ons." Pray, who were they ? and where are they now ? " Down among the dead men." My over-anxious opponent asks, " Is the Canadian Dental College prepared to say that the members of their kindred colleges in the United States are ignorant empirics ?" That will not do, Mr. B. The Dental Col- leges of the United States, as their reports show, do use amalgam, though discriminately ; the Canadian College has not used it as it has hap- pened ; therefore Mr. BowKEti alone is the one who charges " the mem- bers of their kindred colleges in the United States with being ignorant empirics." During a recent trip through the United States I met most of the very leading men in the dental colleges, associations, the journals, &c. and had especial opportunity of finding out the facts as to the use of amalgam. T found one bitter old gentlemen who T nted forth the ancient refrain against its use ; but I also discovered that he never tried to save exposed pulps of teeth, and that in the great improvements in practice he had no faith or share. All unanimously advocate discrimination in its use; use of gold in preference wherever it can bo used; but the old theories I found entirely exploded, and yet the very proper precaution prevailed not to extol it, lest it should lead to over-estimation. Pro- fessor Atkinson, of New York — a very giant among giants in dentistry, whose excellence in operating, keen diagnostic and general scientific u attainments nont can fairly dispute, and who frequently receives $50 and $100 for a single gold filling, and who, therefore, has every reason, were he selfish, to denounce amalgam — w rites to me lately the following replies to questions : — 1. "Will not a properly prepared amalgam, properly inserted, pre- serve a healthy tooth ?" Answer, hy Professor A. — ''Yes, as well a» any other filling.'' 2. " Do you believe there is any possibility of ptyalism from amalgam in the teeth?" Answer, hy Professor A. — " Nay, verily." 3. " Is amalgam not used by very eminent dentists for patients who cannot pay for gold, and for certain classes and conditions of decayed teeth which cannot be well filled with gold ?" Answer, by Professor A. — " Yes, and by those of deserved eminence." I can produce any quantity of such testimony from mostly all the leading dentists: one more will suffice for the present: it is from one of the keenest obiervers and rising men of the profession. Dr. S. P. CutlerJ Professor of Chemistry, Metallurgy, Microscopy, and Histology in the New Orleans Dental College. He says, " Undoubtedly I do think amalgam may not only bo used, but with most decided benefit in a great many instances; where gold cannot be used I would use amalgam for permanent use. I have had several discussions with Dr. Geo. Watt on the subject of amalgam, and I always differed with him ; his conclu- sions were not at all satisfactory to me. I have used amalgam for 25 years quite extensively, and never in any instance have I seen a single well-marked case of disease, either local or general, from its use in my own hands, or in any others. I have seen cases that have been attributed to its use, but without satisfactory evidence. I believe that good amalgam fillings in haiUy decayed teeth, thoroughly introduced i," who does not know " who Mr. B. is " will answer his question. I slu 1 like to know who are practitioners of high repute, when we exclude such men as the above, and the host of eminent dentists, who hold the same views ot amalgam. I am sure that xMr. B.'s (juery will be a source of amusement to the 16 dental prot'ession in general. Possibly he btlieves that as Le- -according to his owp assertion — io the only slcilful ana honest Dentist in Canada, 60 the few extrcipc opponents of amiilgam in Ac United States are the only intelligent ones left since the duys of 1842. Mr. B. says " I ask Mr. Bkers, " Are the physical conditions of the human frame d'.forent in 1870 from what they were in 1847? If the malpractice of uaialgam was determined in 1847, what ciroim- stances can possibly mako its use sound and good practice in 1870 ?" Very easily answered. 1st. I am prepared to debate the former question in the affirmative, at any time. But allowing that they have not undergone any change, I would answer that the common sense and intelligence of 1870, such as shown by Dr. Westcoit, is infinitely in advance of 1847, and I pity him if ho doubts it. But may .. ujk him to point out the divine law which made the dictum of 1847 binding on the generation of 1871; and if it was '* determined in 1847" that there wap no real hope of preserving an abscohsed tooth, why we make efforts and succeed in saving them in 1871. Pshaw? such a question is only fit for a habitant to ask, who clings to his wooden plough, and his poor agricultural ideas, because his fathers taught him to do so. How does the matter stand to-day ? In favor of the discriminate use of amalgam, we have the very leading men in every country in the world ; while on the other hand, they freely admit that gold is the best filling when it can boused to save the tooth. The opinion of John Tomes alone is worth ten times more than that of any prejudiced investigator in • America or elsewhere. I have ore serious question to ask Mr. B., which, with the other points, I beg him not to evade. If, as he asserts, he has always con- sidered the use of amalgam injurious, and has known in his thirty years practice that it was used, and even very much more used formerly than now, why he waited until the present organization and progressive move- ment of the dental profession in Canada — in which he shirked a share — to unburden his mind of his opinions ? He had such a superabundance of conscientiousness all of a sudden, that he felt "it would be a violation both of duty and conscience to remain silent," — j/et he remained so a quarter of a ceatury, and was impelled to come out as an "expositor of the abuses of dentistry," at the very nick of time when dental associations, a college, and a journal were vigorously working for education and reform. One question more, and I have done with Mr. B. The early writers against amalgam held the view that because there wa« mercury in it it was p >isonous. Mr. B. quotes Dr. Geo. Watt and Dr. Tapt, of Cincinnatti extensively. Dre. Watt and Taft say that 17 because there mercury in amalgam it Is poisoriou3. Mr. B, also suysr that the mercuij in the compound is the reason it is poisonous. Well, Dr. Watt says of red vulcanite whi-jh is used .la a base for arti- Icial teeth, tlat because there is mcrcurj in it, it is poisonous. Dr. Taft says it is poisonous. Now wh;it about Mr. Bowker? Oh ! he ha? been using this very red vulcanite since its introduction, and though Dr«. Watt and Taft, who are so great authorities with him against amalgam say it is poisonous, and Prof. Silliman says that one-third jf the whole is sulphide of mercury, and though a host of dentists, chemists and physi- cians arc running the rubber question in the United States just as am- algam was run in 1845, and though Drs. Watt, Taft, &c., say it causes salivation, produces injurious constitutional effects, &c., yet Mr. Bowker places it, not in the bony substance of a tooth, but covering the mucous inembran*? of the hard palate ! And this tirade against red vulcanite •' because there is mercury in it " is of 1870 and 71, not of 1845. Will Mr. Bowker explain this remarkable inconsistency ? Personally I do not believe that if *he rubber is properly vulcanized, kept clean, and removed occasionally — as nature never intended the roof of the mouth to be covered with a foreign base — that it^is injurious or poisonous ; because before the mercury or sulphur can be set free the base must undergo decomposition. The opposition to its use in the States originated when the Goodyear Rubber Co. compelled dentists to pay an annual tax,, and its principal opponents are those who have prepared substitutes to take its place, and which they are anxious to sell. But still there is sul- phide of mercury in red vulcanite, and how does my opponent reconcile his opposition to amalgam, which keeps hard and perfect for years, with his use of a material which wears away in the mouth ; and we know the sulphide of mercury used ip the rubber is frequently adulterated with red lead, and bisulphide of arsenic — poisons which are soluble in the mouth. In conclusion, I hold that if any dentist cxtr icts every tooth he cannot fill with gold, and which can be filled with amalgam, he is guilty of gross injustice to his patients, and gross malpractice. This is the opinion of the leading dentists of the day, and while determining to use gold in every possible case, they are well aware of the risk incurred in extolling a filling so easily introduced as amalgam. There are " cheap dentists " who cannot use gold, and to whose souls a defence of any soft filling is a sweet conso- lation. I do not defend amalgam, or anything else in the hands of the " cheap dentists." But I know that they may make a permanent filling of amalgam, while I know that they cannot make one of gold. Not to mince the matter, the majority of the present extreme opponents of amal- 18 gam, ore all old-foiry practiti«ncr?, who esteem their a^e anil past reputa- tion sufficient reason to dignify tlie most absurd assertions. The progress of dentistry never was much aided by their eflFort«, and never will be. They have fallen behind, and have failed to keep pace with that intel- ligence and freedom from prejudice, which characterize the meu who noic rank highest in the dental profession of every country in the world. [Among the scores of opinions on Amalgam sent us by the leading men in the profession, we value the following from the pen of one of widely recognized ability. Though written very hastely and not exactly for publication, it evinces something deeper than second-hand assumption.] 3Iy Dear tMR, — Your favour of 22 prox. came to hand day before yesterday. I have been experimenting since yesterday morning on amalgams. First, I put into nitric acid one part to four of water, a lump of hard amalgam ; second, hydrochloric acid one part to two of water ; third, sulphuric acid ouo part to two ; fourth, strong vinegar. A lump of dry amalgam has remained in each since yesterday, the only effect noticeable la either is a slight action of the nitric acid, darkening slightly the surface, without any perceptible change; none of the others have under- went any perceptible change, but remain clear and white. Now any of these preparations are sufficiently strong to act with energy on teeth in the same length of time, and any of these acids would if retained in the mouth any length of time, excoriate the entire mucous surfaces. Good amalgams are composed of pure tin and silver, and amalgamated with pure mercury. Water does not decompose mercury silver or tin lo any perceptible extent. Nitric acid dilute acts on silver, also mercury separately and less so on tin. Heat facilitating the action when the three are combined, as in amalgam, the acid action is greatly lessened. I do not believe that any action of the fluids of the mouth is sufficient to produce any mercurial salt capable of acting injuriously to t'le slightest extent, even in cases that have been repeatedly salivated by taking mercurials; if so, I have never witnessed a case during thirty- two years professional observation. I have seen a filling but a short time since, made of silver filings and mercury, that had been in a lower bicuspid twenty-five years, the filling being perfectly sound and the tooth all round except near the gum where a cavity below had nearly reached the filling. This filling was very dark on the surface, but on running a file over it slightly it gave a pure sound white surface, in consequence I left the filling in and filled below it. This dark surface was the result of the silver oxidizing slightly. Remove any amalgam filling from any tooth and file the surface, and the filed portion will become white and metallic. In order to get protoxide of mercury, which is the only one of consequence, lueroury must be heated up to 600 degrees with fiee access of air, then red pre- cipitate is formed, which is the protoxide, and on raising the heat higher, this oxide is again decomposed into the simple elements. .To form calomel, which is a sub-chloride, subnitrate of mercury is precipitated by common salt ; it is also formed by otL-'r processes. Proto- chloride of mercury, or corrosive sublimate, n)ay he made in several ways. When metallic mercury is heated in chlorine gas it takes fire and burns, producing this salt. From the above formulas it will be seen that mercury is not readily acted upon by any fluids that may exist in the mouth, as these fluids always contain at least from 800 to 900 parts of water in 1000 parts, so that any acid or any other agent contained in this fluid could absolutely have no action of any momeiit ; neither in tit^ or silver ; the latter turns dark from an oxide being formed in some mouths much more rcudily than in others; some mouths scarcely acting on a silver plate at al!. Youman says that mercury slowly vaporises at all temperatures above 40 degrees; some say ail temperatures above 06, The vaporisation goes on mere rapidly as the temperature is raised up to the point of ebullition 662. All the apprehension that need give us any concern in connection with imalgam fillings is the vaporisation during the process of hardening, some of which undoubtedly will be inhaled into the lungs, as this vapor must be lighter than air or it could not be a vapor at all. The amount that might oe inhaled would be so insignificant that it would not do any mischief, as it would bo carried out of the lungs again even if it passed the entire rouids of the circulation. Workers, in-quick silver are short-lived, owing to the fact that they arc constantly in an atmosphere charged with these vapors, which no doubt keep their systems saturated during their working hours, which in a few causes a total lesion of nutrition, the hair and nails fall off, the hard tis- sues become saturated ; the periostium fails to nourish the bones, and the poor wretches die from exhaustion. The insignificant amount of this vapor escaping from a fine amalgam filling could produced no injurious effect. The vapor will salivate when BuflBcient has been inhaled, which is the first effect of allmost all forms of mercury, however introduced into the system. Mercury in its action is 20 an irritating stimulant, to the glands more especially, the liver primarilr, the oral secondarily. March 31. — All the specimens have now been in the acids 48 hours, none of them are in the least aiTocte'l, except that in the nitric acid, which is nearly all decomposed, with some precipitate of tin I suppose, at the bottom. It will be seen that in 24 hours there was seurculy any action at all by the nitric acid, and now none at all by any action of the other acids. I think thc.o conclusions are sustained by demonstrable facts as given above. S. P. CUTLER, M.D., D.D.S. Professor of Chemistry, Metallurgy, Microscopy and Hiptology in New Orleans Dental College. New Orleans. liiiUlii^ittttMii