Nothing New Under the Sun Experiences with Mercury Poisoning Related by Dr. Alfred Stock and Dr. E. Jaensch in 1926.

The following is a translation by Mats possible that my problems were caused by an Hanson of an article by Dr. Stock which especially narrow nasal passage and an unusual appeared in 1926 in Zeitschrift fur Ange- sensitivity of the nasal mucosa. My nose was wandte Chemie Vol. 39. therefore treated for decades by etching, burning, massage, electricity and bloody operations. Without When I decide to tell a wider audience results! Two years ago something happened — a everything about personal troubles, which in few of my collaborators fell ill with similar themselves do not concern others and therefore symptoms — and it was revealed that the cause was should not be worth publishing, it is because of an insidious mercury intoxication. Because of my an intense wish to spare others, who have chemical work; the study of volatile compounds anything to do with metallic mercury, the very with vacuum technique using vessels with mercury, bad experiences which have destroyed a major mercury-pumps, manometers and valves, I was for part of my life and to very emphatically warn 25 years in constant contact with mercury. against the volatile metal. I can freely tell about It is today not possible to doubt the causal it today since it is fortunately enough in the connection since all symptoms, even if not yet past and a terminated matter. completely, have disappeared (and a short time ago The insidious dangers of mercury are not clearly reappeared when I for some time worked in sufficiently known and are too little noticed just mercury-containing air because of a mishap with in the places where people are especially the ventilation of my laboratory) when I, for two threatened, that is in the chemical and physical years have protected myself from inhalation of laboratories, mercury vapor. For nearly 25 years I experienced symp- I will next give an account of my symptoms and toms, in the beginning only weak and occa- how they developed with time. They agree, even in sional, in time increasing up to being unbear- detail, with all insidious mercury vapor poisonings, able which caused me to doubt if I could something my collaborators and other chemists continue my scientific work. The cause was not could confirm. They were and are, largely known to me or any of many excellent doctors I unknowingly, victims of mercury vapor poisoning visited to ask for advice. It was considered and did

202 NOTHING NEW UNDER THE SUN not know the source of their troubles. Many in various places, stabbing pains in my back and in essential symptoms have, until now, not been limbs, pressure around the liver, sudden need for sufficiently described and the insidious urination and diarrheas without special reasons. mercury vapor poisoning has not received the Slight vesicles on the inner sides of my arms and on attention it deserves. the upper half of my legs. The matter started with me as periodically The manifestation which was most severe for a occurring light headaches and weak dizziness person with intellectual work was the loss of which increased with the years to continuous, memory. My originally very good memory got nervous unrest and irritability, to a pressure on worse and worse so that I, two years ago, was near my head which made thinking difficult, to ever total amnesia. Only with the help of extensive notes increasing headache, finally almost continuous and with considerable effort was it possible to write and tormenting (mostly over the eyes), to a paper or hold a lecture. I would forget the phone intense vertigo which was connected with number on my way from the telephone directory to troubles of vision (dim and double vision). the telephone; I would forget almost everything I Soon also the upper airways were affected; in had learnt by heart, the contents of books and the beginning light and occasional nasal theatre plays I had recently read and seen, the catarrh, then permanently tight nose, later contents of my own papers I had published. It was almost continuous catarrhs of the olfactory impossible for me to remember numbers or names. mucosa with often bloody mucus production Often I could not remember the names of close and crust formation, violent throat friends. Especially the ability to calculate, to do inflammations and pains in my ears connected mathematical thinking, also to play chess, was with depression of hearing and smell (for some severely affected. The depressed ability to substances like hydrogen cyanide it remained), remember and the difficulties in calculating seem to distaste for tobacco smoke. In the last few be a special sign of insidious mercury vapor years before the cause was recognized, other poisoning. This was also evident with my symptoms appeared: salivation, sour-stale taste collaborators and with other persons, for a long in my mouth, eye inflammation, inflammation time exposed to mercury vapors, cases which have of the oral mucosa and vesicles, sensitive and now become known to me. Shortly after we had ulcerating spots on my tongue, gums, gingiva, discovered what was wrong, I and two collaborators insides of lips and cheeks, redness of gums and were trying to finish writing a paper which needed slight bleeding during toothbrushing, calculations. None of us had the ability to add 10- toothache, withdrawal of gingiva from teeth 20 large numbers without errors! and the appearance of pockets, occasional In contrast to only a small effect on bodily loose, single teeth. The mouth and teeth strength, for instance during mountain climbing, the changes occurred late with me (the peak of intellectual capacity was also in other ways these symptoms did not occur until months depressed although not as severely as memory. In after the poisoning had been discovered) since I addition there was psychic depression, a painful from childhood had been careful with my inner unrest, with time also causing disturbed sleep. mouth hygiene (for instance every evening 1 By nature fond of company and full of enjoyment prolonged rinsing with 1 /2 percent hydrogen of life, I withdrew in misery into myself, avoided peroxide solution and then with sodium public relations, people and social contacts, lost the bicarbonate). If this had not been the case I love for art and nature. Humor rusted in. might have discovered the cause of the Difficulties which I earlier had cleared with ease symptoms earlier because of the mouth (and today again can clear with ease) appeared inflammations. insurmountable. The scientific work required Further symptoms were: intellectual ex- considerable efforts. I forced myself into my haustion and depression, lack of energy and laboratory but could not produce anything of value ability for work, especially intellectual work, despite all efforts. My thoughts were heavy and increased need for sleep, trembling of my pedantic. stretched fingers, often also my eyelids, pains 203 ORTHOMOLECULAR PSYCHIATRY, VOLUME 12, NUMBER 3,1983 Pp. 202-207 I had to give up participating in matters which in a small room. The measurements required were not of immediate importance. The constant temperature and therefore windows and lectures, previously something I liked, became doors were kept closed. The work had to be tormenting. The preparation of a lecture, the finished before early 1924 since my assistant was to writing of a paper, even a simple letter, take up a post in industry and the Spanish colleague required immense efforts in handling the had to go back to his home country. Therefore the contents and language. Not seldom it happened work was rushed and the careful cleanliness we at that I wrote words wrongly or forgot letters. To other times kept, was neglected in this room and be aware of these shortcomings, not to know scattered mercury was left unattended in cracks and their cause, to know no way of getting rid of joints in the floor and under laboratory stands. In- them, to expect further deterioration — that stead of an insidious mercury poisoning the was not nice. conditions were given for a more acute and more All efforts to improve my condition failed. easily recognizable mercury intoxication. The Several weeks in the mountains was of no use; assistant fell severely ill, not just with headaches I did not feel less miserable there than in and intellectual depression but also with severe Berlin. The nasal treatments and operations bodily deterioration, ulcers in the mouth etc. His often gave short, not lasting improvements. It brother, a doctor, thought that the condition was remarkable that all psychic symptoms reminded him of mercury poisoning. The renowned disappeared for hours when the doctor treated toxicologist, L. Lewin, whom we called for, certain places of the upper nasal mucosa with examined the laboratory personnel and declared, cocaine; if the correct spot was treated, that according to his experiences, we were all with headache and vertigo disappeared, often within certainty suffering from mercury poisoning. a few minutes. Memory, ability to work and Mercury was found in the air of the laboratories good spirits reappeared, however, only as as well as in the urine of all affected persons. The passing guests. I often used the method to recall mercury concentration in the air varied from room my ability before a lecture, an important to room, from a few thousandths to a few meeting etc. hundredths of a milligram per cubic meter. That is As I have already mentioned, also my only a small fraction of what air can contain when collaborators in the laboratory; assistants, Ph.D. saturated with mercury vapor (about 12 mg/m3). students, technicians, had various symptoms: Since a human being breathes about 1/2 m3 air each depression without apparent cause, bad hour and the inhaled mercury, as it appears, is memory, headaches and dizziness, now and largely absorbed in the lungs, only a short visit in then gastrointestinal troubles, limb pains, slight mercury saturated air is sufficient to elicit an acute mouth inflammations, nasal catarrh etc. With mercury poisoning. one person some symptoms were worse, with When air containing small amounts of mercury is another some other symptoms, apparently for inhaled, it will take a long time until the poisoning each person at his weakest point. All showed becomes apparent. For one to several years the tiredness and depression of intellectual symptoms can be restricted to tiredness and slow capacity. However, nobody got the idea that deterioration of the intellectual ability and memory. there could be a common cause for all of us. For instance with the Spanish guest, inflammations Not until a happy - unhappy event finally in the mouth did not appear until at the end of the opened our eyes. year he stayed with us and reached their peak a In order to save money we had in 1921 month after he had left us and was not exposed to disconnected the ventilation aggregates of our mercury any more. The psychic effects he had felt Kaiser-Wilhelm Institute of Chemistry; earlier without knowing their cause. "It was as if I aggregates which consumed much expensive became more stupid in Germany." And similar electric current. Since the middle of 1923 two observations I could make on my other of my collaborators, an assistant and a Spanish collaborators. Almost all Ph.D. students in my guest, were working on density measurements laboratory had difficulty qualifying

204 NOTHING NEW UNDER THE SUN for the doctor degree. If the students and takes years to excrete the mercury which has been assistants left the laboratory after a few years, taken up by the body for years. they recovered without knowledge of the It appears that from a mercury poisoning follows mercury poisoning. On myself, the effects of a special sensitivity towards a new exposure for the minimal amounts of mercury developed as I mercury vapor. Some of us, who because of work have described. or faults in the ventilation system, were again Especially significant for this type of insid- exposed to mercury, felt it immediately as an ious mercury poisoning are sudden changes in increasing number of relapses. That seems the condition. After a few weeks of better understandable since the long time for development health follows, often quite suddenly, a time of of the disease shows that a certain threshold must worse conditions. This also holds true for the be reached before symptoms appear. The threshold relapses during recovery. When my disease was will certainly easily be reached again during at its peak, the general rule was: one or two recovery and any additional amount of mercury days of endurable conditions, then increased will worsen the condition. salivation and nasal catarrh including catarrh in We tried in various ways to enhance the recovery larynx and bronchi, inflammation around teeth, on advice from doctors; using diuretics and severe weakness and dizziness, tormenting substances to promote fecal excretion, taking hot headache, often also joint pains and diarrhea. baths, eating small amounts of sodium iodide. I The headache, dizziness and weakness of have not the impression that the recovery was memory are connected to the nerves in the substantially enhanced through these measures. upper part of the nose as the effects of the Iodine is supposed to bring the metal into solution cocain treatment has shown. from insoluble organic mercury compounds, the The recovery from insidious mercury form in which mercury probably is bound in the poisoning, after elimination of the poison body. I could not demonstrate on myself that source, is extremely slow and there are often significantly higher amounts of mercury were relapses. Professor Lewin told us so and the excreted in the urine after iodine intake. We did not development of our conditions has proved him expect the diuretics to have any effect since we had right. The necessary time apparently depends shown that mercury excretion in the urine soon on the length of poisoning, maybe also on the stopped. The art of medicine unfortunately has no person's age. My collaborators who left the substance which can detoxify the body from laboratory fortunately recovered within one or mercury. two years from all symptoms and have recovered their powers of thinking and memory To be in the fresh air seems to be most useful to the full extent. But also these persons had to for making subjective symptoms less felt. Novalgin endure relapses of psychical and physical has some effect on lighter headache and dizziness. character (especially mouth inflammations). In general one has to let time take away the Some of the assistants and technicians continue disturbing influences on the body. Some weeks working here and we can unfortunately not visit in the mountains and a voyage at southern avoid using mercury. They have now, nearly latitudes brought me hardly any faster recovery two years after the poisoning, clear but ever than at home, although the psychic rest had a weaker symptoms. I was exposed to the positive effect on my nerves. damaging effects for more than 20 years and Why was our disease not recognized as mercury the complete recovery apparently takes the poisoning earlier? I have often asked myself this longest time; the capacity for work is almost question, not without reproach. The first symptoms back, only occasional relapses (headaches, of the slow mercury intoxication, before any oral dizziness and mouth inflammations) affect me symptoms appear, are hardly known to the medical slightly. Judging from the development of world. They are tiredness, depression of thinking recovery so far, I do not doubt that all of my and memory, light headache and dizziness, collaborators and myself will completely occasional diarrhea. Neither was it known that the recover from all symptoms. It is likely that it nose and the upper airways

205 ORTHOMOLECULAR PSYCHIATRY, VOLUME 12, NUMBER 3, 1983 Pp. 202-207 were affected. Just this started myself and my 1.000 g, three weeks hardening, 9 days heating, doctors on the false track and has also fooled cooling with ice: 8.2 mg mercury. others I know of. One of my assistants was for a 4. Amalgam filling which had been in tooth for a long time treated for sinusitis until the true cause year and had fallen out. was found. Also the difficulties in thinking make it Weight 0.894 g, 14 days heating, liquid air cooling: difficult for the affected person to make a correct 29.4 mg mercury. Undoubtedly fillings like these will diagnosis of his troubles: Quern Mercurius perdere also slowly give off mercury in the mouth and give vult, dementat prius! the inhaled air a low level of mercury which must be It is appropriate in this context, to warn of harmful in the long run. The old copper and cadmium another source of insidious mercury intoxication; amalgams should be even more dangerous. dental amalgam fillings. Prof. Lewin advised me Dentistry should completely avoid the use of immediately he had diagnosed the mercury amalgam for fillings or at least not use it whenever poisoning, to exchange for other materials the that is possible. There is no doubt that many amalgam fillings I had in considerable numbers symptoms: tiredness, depression, irritability, vertigo, since early youth. He called attention to a case he weak memory, mouth • inflammations, diarrhea, loss knew of, a university colleague (Prof. Jaensch, of appetite, chronic catarrh often are caused by Univ. of Marburg) who was on the border of mercury which the body is exposed to from amalgam psychical and physical collapse when the cause, in fillings, in small amounts but continuously. Doctors the nick of time, was found to be the numerous should give this fact their serious consideration. It will amalgam fillings he had since youth. After their then likely be found that the thoughtless introduction removal he slowly recovered. of amalgam as a filling material for teeth was a severe The dentists formerly preferred copper and sin against humanity. cadmium amalgam and today use silver amalgam for filling teeth since these amalgams are easy to Letter from E. Jaensch, professor in psychology in manipulate and fill the cavities well. Silver Marburg to A. Stock, professor in chemistry at the amalgam is better than the other amalgams which Kaiser-Wilhelm inst. for Chemistry, Berlin. The letter corrode considerably with time. However, also was published in Zeitschriftfur Angewandte Chemie silver amalgam gives off mercury vapor at oral 39, 461-488, 1926, in a paper by A. Stock: Die temperatures, which the following experiments Gefahr-lichkeit des Quecksilberdampfes und der proved. Amalgame (The Hazards of Mercury Vapor and We sealed silver amalgam pieces in glass tubes, Amalgam). bent into right angles, evacuated them and heated Translated by Mats Hanson, Dept. the horizontal part with the amalgam to 30-35°C, ofZoophysiology, Univ. of Lund, Sweden. cooled the other part in ice or liquid air and You do humanity a favour when you take up the determined the amount of mercury which distilled question about amalgam. At about the age of 15 my over. teeth were, as the saying is, put into order. I had 1. Amalgam piece, carefully prepared by a fillings in a large number. Gradually persistent dentist from metal powder and mercury for troubles appeared which at first restricted themselves this experiment. Weight 0.801 g, sealed into to the nervous system. The condition was diagnosed the glass tube 24 h after preparation, heated as hypochondriac neurasthenia since the symptoms for 23 days, ice cooling. Amount distilled were only of a nervous character and since I in over: 11.2 mg mercury. general appeared to be in good health. 2. Similar, weight 0.810 g. Three weeks after At the end of my student time I had again distinct preparation to obtain as complete hardening nervous and also bodily symptoms. The troubles as possible and then sealed in a glass tube. increased year by year. The beginning of the Heated for 12 days, cooling with liquid air. deterioration was clearly associated with an unusually Distilled over: 15.3 mg. large and especially unskillful dental treatment. I had 3. A piece of amalgam, carefully prepared mostly so called contour fillings and a distinguished with as little mercury as possible. Weight dentist now told me that "to prevent anything 206 NOTHING NEW UNDER THE SUN more from happening" he had to connect the amounts. In the saliva mercury could not be adjacent fillings in the molars and he made detected with certainty. The source of the mercury these solid connections. seemed to be the many amalgam fillings the patient From 1909 my condition deteriorated ... had in his mouth for many years. The previous chronic, worse and worse diarrheas and I lost history fits completely the assumption that it is a much weight. In addition intense pains in all toxic disease caused by mercury.) parts of my body, my sleep worse and worse, Now we faced the almost impossible task of inflammations in my mouth with increased finding a dentist who could be persuaded to take salivation ... worse inflammations in the upper out and replace the fillings. Again and again I was airways, especially in my throat ... painful dismissed. Everywhere the dentists pointed out that asthmatic condition, intense anxiety and the harmlessness of amalgam fillings was proved, deterioration of my physique so I could only that Sommer's records could not be believed and leave my bed for short times. Complete that no dentist could take the responsibility for impairment of my intellectual ability. such a large and "unnecessary" operation. Prof. X I was on sick-leave for a year and my life at the emperors court, told me: "You can send me was a futile wandering around to medical reports from all the medical specialists in the world specialists in Baden-Baden, in hopeless resig- — I don't believe it." nation, when in the summer of 1916 I met my And all that only because Witzel apparently had former acquaintance Professor Sommer from "proved" the harmlessness of amalgam fillings, Giessen. I told him about my condition and also partly against a considerable resistance among the of a recent thought. I had suffered from older dentists. (Witzel: Das fullen der Zahne mit toothache and had, in front of the mirror, Amalgam, 1899). (Translator's note: Witzel in contemplated my set of teeth with its in part Germany played the same role as Black in the very large amalgam fillings (18 silver amalgam USA.) When I had obtained Witzel's book I was fillings). Then I had recalled a remark which I shocked by the shallowness of these proofs. had heard from one of my doctors. I had It might not have been possible to find a dentist wondered if I could have contracted lead who could exchange the fillings if Prof. poisoning since I had worked with Binswanger had not explicitly asked a relative of accumulators and had the answer, "It is his who was a professor in dentistry. When the certainly not lead poisoning, it rather looks like fillings were drilled out I had increased troubles. mercury poisoning. But that's an impossibility When we sucked away the amalgam dust during — where should that have come from?" the rest of the work the troubles did not appear. When I now contemplated my large number Immediately after the removal of the amalgam of amalgam fillings in my mouth I got the idea fillings a considerable improvement, compared to that might it not after all be mercury poisoning. the previous condition, started. Even if the rest of Sommer told me that he had a significant the recovery was slow, the time of the removal of number of similar cases which, by closer the fillings constituted the turning point after which examination, had proved to be toxic all the troubles in the digestive and respiratory polyneuropathy. organs as well as those in the nervous system, My urine and saliva were tested for mercury. steadily decreased so that I now, for the first time The clinical and chemical examination gave the really know what it is to live. results which are written in the records of Prof. How many people suffer in the same way, even Sommer. (In these records from 1916 one can if it is to a lesser degree and how many such cases read: In the urine was mercury in considerable remain forever undiscovered? 207