When the Crawcour brothers opened for business in New York in 1833, they didn鈥檛 have to wait long for their first clients. To anyone with tooth troubles, the brothers鈥� advertisements were irresistible. Why pay a fortune to have your cavities plugged with gold when two brilliant dentists from Europe could fix them with a miraculous new sort of filling. With their amazing Royal Mineral Succedaneum, they could make a tooth as good as new-cheaply, painlessly and in just two minutes.
People flocked to the Crawcours for treatment. Not only were the new fillings affordable, there was no need to spend hours in the dentist鈥檚 chair, mouth clamped uncomfortably open while the dentist hammered gold foil into the hole in your tooth. New York鈥檚 dentists watched in dismay as their surgeries emptied. And when their profits began to plummet, they decided it was time to declare war-not on the Crawcour brothers but on their 鈥渧ile amalgam鈥�.
THE Crawcour brothers recognised a get-rich-quick scheme when they saw one. Fast, cheap fillings were guaranteed to turn a pretty profit. And just as they expected to make a killing, the brothers also expected to make a few enemies. What they didn鈥檛 expect was all-out war.
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Since the earliest times, people have stopped up holes in teeth with fragments of coral, wads of cloth, plugs of cork, waxes and gums, and later with various types of cement. Most of these fillings fell out within days. By the 18th century, French dentists had begun to experiment with metal fillings, battering lead or thin foils of tin and gold into the cavity with a mallet. Even these didn鈥檛 last. Bacteria slipped into the tiny gaps around the filling and decay began again. Then, in 1826, Frenchman Auguste Taveau began to plug cavities with 鈥渟ilver paste鈥�, an amalgam of silver and mercury. The silver dissolved in the liquid mercury to form a soft paste that could be worked into a hole of any shape. Once in the cavity, the paste crystallised into a hard plug.
Taveau鈥檚 paste was cheaper and easier to manipulate than gold. But it had drawbacks. When the amalgam hardened it expanded. Sometimes the filling bulged above the tooth, interfering with the patient鈥檚 bite. Sometimes the expanding plug cracked the tooth apart. Taveau鈥檚 silver paste wasn鈥檛 popular with patients. Yet if amalgam could be made more stable, it had huge potential. The Crawcour brothers made sure that potential wasn鈥檛 realised for more than half a century.
The Crawcours were quack dentists who plied their trade in Paris and London before heading off to New York to make their fortunes. Many itinerant tooth doctors were highly skilled. The Crawcours weren鈥檛. Their expertise lay in self-promotion. The brothers made amalgam by filing down silver coins and dissolving the filings in mercury. They called the mixture Mineral Succedaneum-or replacement mineral-adding the Royal to give it extra cachet. The pair did live up to one of their promises: they were quick. The faster they worked, the more money they made. They didn鈥檛 waste time cleaning out cavities to halt decay, they simply shoved in a dollop of amalgam and pressed it down with a thumb. The poor quality of the fillings only became apparent a few days later.
Despite their sloppy work, the brothers鈥� adverts continued to pull in patients. Soon the city鈥檚 professional dentists were twiddling their thumbs while their clients queued up outside the Crawcours. They had to do something to protect their business. First they attacked the brothers: they were immoral, unscrupulous and incompetent-no better than quacks and charlatans. When that didn鈥檛 work, they tried another tactic. They attacked the brothers鈥� materials.
Amalgam, declared the city鈥檚 dentists, was not fit to put in people鈥檚 mouths. They pointed out that mercury was one of the deadliest of poisons. When it seeped from fillings-as it must, they claimed-it would do terrible things to the body. The attack on amalgam was so relentless, the Crawcours packed up and left town.
With the enemy gone, that should have been the end of the amalgam war. It wasn鈥檛. The dental establishment had denounced amalgam so forcefully, it couldn鈥檛 possibly admit that the 鈥渧ile stuff鈥� might have some merit after all. The battle continued. When teeth fell out or jawbones rotted, amalgam was blamed. Any sickness without an obvious cause was invariably the fault of fillings. Amalgam was accused of causing strange cases of paralysis, all manner of throat diseases-even tuberculosis.
Right from the start, however, some dentists found the narrow-minded prejudice against amalgam hard to swallow. There was simply no evidence to suggest it was harmful, and in skilled hands it was a most promising material. Some began to try it out. The dental establishment acted swiftly to nip this rebellion in the bud. In 1843, the newly formed American Society of Dental Surgeons declared that any member using amalgam was guilty of malpractice. When the society found some dentists ignored its ruling, it insisted members sign a pledge promising not to use amalgam.
But the rebellion was spreading. Some dentists experimented openly with amalgam and were expelled from the society. Some denounced the stuff in public, but tested it out on the quiet. The war on amalgam had become a civil war. Instead of dentists fighting quacks, they were fighting each other.
While the rebels gathered evidence in favour of amalgam, the anti-amalgam forces continued to denounce it at every opportunity. One of their favourite cases, wheeled out at regular intervals, was the sad tale of Mr Ames, an American mechanic who had his teeth filled with amalgam during a visit to London. As he crossed the Channel to France, his fillings began to fall out and he swallowed some of them. By the time he reached France, he was very ill. When he eventually reached the US, he grew sicker still and died. Let that be a warning to anyone tempted by amalgam fillings.
But the story didn鈥檛 stand up to close scrutiny. One sceptic, a dentist called Cook, decided to look into the case. In 1867, he reported his findings in the Dental Times. 鈥淚t is now my full conviction that it was a case of syphilis, that all the symptoms were of the syphilitic type. It was so pronounced by French physicians at the time. His attendant at home so regarded the case . . . Amalgam had nothing to do with the death of Ames.鈥�
As the anti-amalgamites began to lose ground, their attacks grew wilder. In 1874, a Dr Payne claimed in the Dental Cosmos that 鈥渘either Asiatic cholera, nor smallpox nor any malarious disease, is doing half the mischief鈥� that is being done by this poisoning.鈥�
The tide finally turned in the late 1870s, when one of the most respected dentists in the US, Joseph Foster Flagg, came out in favour of amalgam. After years of experiments with many different formulas, he concluded that teeth filled with amalgam lasted better than those filled with gold. It was time to call a truce. By the end of the century, amalgam fillings had become standard treatment. The first war against amalgam was over.