NEW YORK STATE COLLEGE OF AGRICULTURE, Mrs. JOSEPHINE MCQUEEN, McQueen Farms, Loudon, Tenn. DEAR MRS. MCQUEEN: Thanks for your letter of recent date. I cannot see how your information concerning fluoridation of water can be out of date. I believe the following facts still stand. In the first place, I know of no physician in any health department who has ever done any work with fluorides. In the next place, I know that among dentists there is substantial division in the regard to the use of fluorine in water, although dentists will not express themselves in public because they fear bad public relations if they vote against fluoridation. Finally, I know of no foreign country that is making use of fluorides in water, although I am certain that teeth in countries such as England, Switzerland, and Sweden are bad or worse than those in America. I also know that while I was living in Switzerland, there was a scientific commission considering the problem and this commission had been in existence for some time. If this panacea is a hundred percent satisfactory, why have these scientific commissions that are under far less political pressure than they are in the United States refused thus far to put fluorides into any of the water of these foreign nations? I understand that when the representatives from England came to visit this country, they were piloted around in much the Russian fashion showing them only the people in favor of fluoriding water. I cannot see how any of these facts have grown out of date if you have them. I, myself, believe that all of us wish to do the best possible for the children, but that we do not wish to dive into this matter in a huge nation when smaller nations with scientists who are equally as good are refusing to go in. Yours sincerely, CLIVE M. MCCAY, Professor of Nutrition. Then, I also respectfully ask that the committee give consideration to the statement made by Thomas H. Allen, president of the Memphis Light, Gas, & Water Division of the city of Memphis. Mr. Allen has had much technical assistance and advice in the preparation of this statement, and this, coupled with his many years of experience in the water division, makes him extremely well qualified. This is a revised copy and was submitted to me by Mr. Allen with his letter of April 19, 1954. MEMPHIS LIGHT, GAS & WATER DIVISION, CITY OF MEMPHIS, Mrs. Toм MCQUEEN, Loudon, Tenn. DEAR MRS. MCQUEEN: Enclosed is a revised copy of Fluoridation of the Memphis Water Supply. My reasons for making revisions are as follows: Page 2, the paragraph relative to iodine tells the story correctly, but it was put into practice in such a small area that it could be misunderstood. In fact, it has been misunderstood. It was found that salt containing iodine could be used without running the risk of giving iodine to people who did not need it, and the result was that this whole program was dropped by the public health service. The statement in my original paper is correct, but the whole program did not get very far before the change in policy was announced. Referring to ninth paragraph on page 6, we found that it would be better to make a broader statement relative to the differences in the different types of fluorides, and a new paragraph has been substituted for the original one. As revised, this paper may be used. I will appreciate your returning the first copy to me. Very truly yours, THOS. H. ALLEN, President. FLUORIDATION OF THE MEMPHIS WATER SUPPLY THE PUBLIC GOOD The Board of Light, Gas & Water Commission is ready to do everything that contributes to the public welfare. When convinced that fluoridation of the Memphis water supply will contribute to the welfare of all the people, I can promise that no time will be lost in putting in the equipment necessary to do the job regardless of the energy required or of the cost. However, it is an obligation of the board to supply a safe, sanitary water for public consumption. Pure water is an essential. It is the most important of the three services rendered by the division. Until the evidence is completely convincing, I am sure that this board will not add fluoride to the water supply. I have been accused of being bullheaded about this. I am and will continue to be until I am sure that any change made in the water supply is, in fact, for the benefit of all the people. This is my duty. Surely nobody would want those in charge of the water supply to be otherwise. I, therefore, plead that we approach this problem with recognition that we should be hard to satisfy and that no amount of pressure should make us yield in this matter; and likewise if convinced that fluoridation is for the best and that no amount of pressure should deter us from adding fluoride to the water. First Controlled studies, under scientific supervision, are under way in only a few cities. These experiments have not been underway for a sufficient length of time to establish any conclusive facts as to either the benefits or ill effects of fluoridation on the complicated human system. Years ago when I was a young man, the dentists solved many problemstemporarily by killing the nerves of the tooth. It took time to develop the disastrous effect of that mistake. Of more recent date, I recall so many teeth that were condemned because they were dead. These are all recollections and nothing more. I am sure you get the point. Second: How much fluoride? The University of New Mexico, where large areas are blessed or cursed with too much or too little fluorine, has made studies relative to fluorine poisoning and mottling of the teeth in various degrees. The destructive effect of too much fluorine upon human teecth can be horrible to the person so affected. It has been brought to the attention of the public that a water supply having 0.5 part per million of fluorine produced mild fluorosis in 9 percent of the children 12 to 14 years old, and that a supply of 0.7 part per million produced fluorosis in the same age bracket of 12.6 percent. It is proposed to add 1 part per million to 11⁄2 parts per million to the Memphis water. These recommendations and discussions do not take into account the different chemical characteristics of the different water supplies. Perhaps it makes no difference. But Ohio River water at Cincinnati and Louisville, water from the Great Lakes, Mississippi River water, and Memphis well water are not the same. Climate and geography may have a bearing. These questions have been raised; they have not been answered. The amount of dosage of any medicine for one child would not necessarily be correct for another child. Surely the correct dose for a 2-year-old would not necessarily be correct for a 12-year-old. And no matter what the dose, what effect will 1 percent of fluoride have on old people, on sick people, on bones, on lungs, or joints? Third: By what authority does an individual or group have to administer medicine to another person for treatment of an uncommunicable disease? Do any of you contend that we have a right to prescribe medicine for you and your children whether or not you want to take the medicine? Very few individuals stop me on the street or elsewhere to urge fluoridation. Many stop me to protest the use of fluoride. Do we have a right to administer a medicine to those people in the absence of the threat of an epidemic-medicine they do not want to take? Admittedly, fluorine is a rank poison, and, admittedly, just the proper amount should be added. This amount is usually referred to as 1 part per million. It has been suggested by a State public health official that should Memphis add fluorine this dosage should be reduced to 0.8 part per million. What this means is, that if you put 1 ounce of fluorine in 7,500 gallons of water it will be too much. This should be reduced to 0.8 of an ounce to be proper. In other words, there is a difference of 20 percent between what is good and what is bad. Is it not common knowledge that the water intake by individuals and the ability of individuals to assimilate elements varies much more than this 20 percent, and, therefore, is it not clear that there is no way to add any of the presently available fluorine compounds to a public water supply except that the amount added may be proper for some, but will definitely be improper for many? This should indicate that a dosage of fluorine as now constituted suited to a particular bracket and administered to all elements of society certainly appears to be an inaccurate, unscientific, and unprofessional approach to a health problem. It is so important to limit the amount, yet it never seems to occur to the dentists that one person will drink more water than another, and more in hot weather than in cold. So many questions go unanswered that I become fearful that the whole program is carelessly conceived. Fourth: Should we use fluorides on our lawns, in steam plants, electric batteries, bakeries, and all the other commercial and industrial plants whether they like it or not? Perhaps it will do them no harm. Should this not be predetermined by exhaustive tests? Fifth: The Public Health Service states: "National organizations of professional health workers, impressed by the findings of decades of research on fluoride and dental decay, have endorsed the adding of fluoride to community water supplies. They include: American Dental Association, State and Territorial Dental Health Directors, American Association of Public Health Dentists, Public Health Service-Federal Security Agency, State and Territorial Health Officers, American Public Health Association, and American Water Works Association." This statement is not so. The correct statement can be found in the Journal of the American Water Works Association, volume 41, page 575, which reads as follows: "THE FLUORIDATION OF PUBLIC WATER SUPPLIES "STATEMENT OF RECOMMENDED POLICY AND PROCEDURE "In communities where a strong public demand has developed and the procedure has the full approval of the local medical and dental societies, the local and State health authorities, and others responsible for the communal health, water departments, or companies may properly participate in a program of fluoridation of public water supplies." This is not an endorsement. Waterworks men are mostly engineers and chemists dealing with the ordinary problems of water supply and water treatment. They are not equipped by training to deal with a medical problem such as fluoridation. This statement clearly states that if those responsible for the health of the community will take the responsibility for fluoridation, that the water departments may participate by actually adding the fluoridation, that the water departments may participate by actually adding the fluoride to the water. And, in the recommended procedure, the water utility should be relieved of all liability. Sixth: But I see no way for the water department to escape liability. Apparatus may go wrong, men may make mistakes, and overdosage may result. If your children or grandchildren (I am concerned about the grandchildren) turn up with mottled teeth, who pays the damages? Will the Council of Civic Clubs write the guaranty to hold the division harmless and back it with liability insurance of sufficient amount to cover the possible claims from 400,000 people? Seventh: The dental society has instigated numerous statements on fluorine but has failed to tell the public what a local dentist told a group in Memphis, which was that, in general, dentists do not like to serve children and that by putting in the same time on adults, they can gather in more money. certainly most dentists have received their education and training largely at public expense, they should feel obligated to serve all elements of the public, including children. Since Eighth Statements have been made to the public that by adding fluorine, an improvement of 65 percent results. This is a figure obtained by projecting a curve into years ahead and is not the record of what has actually been accomplished. Since this is the case, one would be interested in how the figure of 45-percent improvement resulting from topical applications was arrived Since all the emphasis on fluorine has been in one direction only, it could be that the 65-percent figure is too high, and the 45-percent figure is too low. at. However, assuming the figure of 45-percent improvement, resulting from topical applications, to be correct as claimed by the dentists, is it not commonsense to send the child to the dentist every 2 years and have fluorine applied? This visit should be made regardless of fluorine, and while there the simple application can be made, thus bestowing its benefits to the one who needs it, without involving the many thousands who cannot profit by its use and do not choose to be forced to swallow it. In any event, this procedure for better or for worse limits the hazard to those who wish to take the chance. Ninth As I understand it, fluorine is present in many foods and is essential to the human body. Sodium fluoride, the substance proposed to be used in our water, is a deadly poison, and is entirely different from the various complex fluorine-bearing compounds, organic and inorganic, occurring in nature. Tenth: When I first heard of the proposal to fluoridate public water supplies as a cure for decay of teeth, my immediate reaction was "wonderful." It seemed so easy to do. When I learned that too much fluorine might discolor, mottle, or destroy the teeth, requiring accurate control of the amounts introduced into the water supply, I decided that the program could be a first-grade nuisance to the water division. Every time a mother found a cavity in a youngster's tooth we would be at fault for not providing enough fluoride; and whenever some youngster developed discolored or mottled teeth, the wrath of an outraged family would be unsparingly poured upon our heads. As a nuisance possibility it made me shudder, and I began to be afraid of it, because if it could be a nuisance, it could be dangerous. Sabotage is an ugly word. The enemies of America have not overlooked the possibility of using the water supplies of the country to sabotage the health of the people. It is an item that has given us some concern in preparing the civildefense measures necessary in case of war. If we fluoridate our water, we will equip all of our plants to inject a deadly poison into our water. Has it occurred to any of you here that saboteurs, just one in each plant, by turning a valve, could inject a tasteless poison into our water in deadly quantities? CONCLUSION Speaking for myself only as an officer of the water division, I am not convinced that fluoridation is desirable, or even safe. It should be understood that I have not reached any final conclusion about the matter other than a definite decision that we should not risk spoiling the best water supply in the Nation unless there is definite and conclusive proof that the addition of fluorine to Memphis water will be of benefit to all the people, worth what it will cost, and that the use of fluoride is safe for all the peopleyoung children, old people, well and sick people. Since the responsibility falls on the city government and the division, I feel, in the absence of convincing proof, that the answer should be "No." In conclusion, Mr. Chairman, I feel sure that the committee will give equal weight to both sides of this important issue since undoubtedly it will directly affect all of us and all of our families. I feel that in view of the serious consequences of fluoridation the committee should exhaust every possible means of investigating this proposal before taking favorable action. STATEMENT OF VIEWS ON PROPOSAL TO MAKE IT UNLAWFUL TO ADD ANY FLUORIDE COMPOUND TO PUBLIC DRINKING WATER, BY H. L. PRESTHOLDT This statement refers to H. R. 2341, introduced by the Honorable Roy Wier, intended to make it unlawful to dissolve any fluoride compound in waters intended for human consumption. For the purpose of this statement, whenever fluorine, fluoride, sodium fluoride, or the fluosilicate, or when any of these terms are used it means, and the reference is to a fluoride compound irrespective of its nature, composition, or physical property. The element fluorine is a member of the halogen group. It is extremely poisonous, dangerous to handle, and found in nature usually in combination with calcium. Several years ago, it was brought to the attention of several scientists that wherever the soil or water contained quantities of fluorine, that invariably in such areas, a number of people suffered from fluorosis. Considerable work was undertaken at that time to discover some practical means by which the fluorine or fluoride could be removed. Sodium fluoride is the salt of an alkali and hydrofluoric acid. This acid is the result of a combination between the fluorine gas and the element hydrogen. When the element sodium is added it will combine with the acid to form sodium fluoride and by adding silicon, it will then form the sodium fluosilicate. Both of these salts are extremely poisonous and are frequently compared with arsenic, but they are considered more dangerous because of the great affinity of fluorine for calcium. Salts or compounds containing fluorine are not recognized as having any therapeutic or medicinal value. A thorough search of medical literature does not establish or reveal any pathological condition where a fluoride compound is recommended either for internal or external use. Physiologically, the sodium fluoride or the fluosilicate appear on the market in a white, heavy, dust-fine power. It is being offered in two distinct grades, the commercial and the chemically pure. The commercial grade contains from 90 to 95 percent of sodium fluoride, the balance being inert or impure ingredients difficult to dispose of or remove. It is tasteless and odorless and completely soluble in water; and, because of these characteristics, it has been used extensively as a rat poison or pest exterminator. The principal source of the fluorides are the piles of slag containing the element fluorine and is the result of the use of cryolite in the extraction of the metal aluminum. Sodium fluoride or the fluosilicate does not appear in nature as such. They are manufactured and usually from the leftovers at the aluminum plant. The piles of these byproducts are difficult to dispose of as it is largely waste and because of the danger associated with any materials containing fluorine, it has been a manufacturing problem for many years. There has been a great struggle going on for considerable time to dispose of this waste. It is not permitted to be dissolved in rivers or streams. It is against the law to dispose of this material in the river or sea. The reason why is due to the inherent risks with possible effects on wildlife and farm stock. Great effort has been made to find an outlet for the fluorides. It is used quite extensively in art and industry especially in manufacturing adhesives and paints, but there is not sufficient industrial use to consume the constantly increasing quantity of waste containing fluorine, largely due to the enormous expansion and development of the metal aluminum industry. For almost a generation, it has been recognized that in the fluoride sections of our country-notably the States of New Mexico, Arizona, Colorado, and certain counties in the State of Texas-there is a percentage of fluorine in the water and the soil. It is in these localities where endemic fluorosis is prevalent both in humans and the animal kingdom. This discovery has led to many different opinions, but scientists have definitely brought out the fact that when young children in the age group from 8 to 10 years ingest fluorine or its compound that the incidence of dental caries are somewhat reduced as compared with similar conditions existing in localities or other States where the fluorine content of soil and water is practically nil. It is not generally understood how nature dissolves the fluorides because calcium fluoride is insoluble. Somehow, nature has converted the calcium fluoride into a soluble substance where it is even possible for plantlife to absorb it and vegetables grown in soil tinctured with fluorides are found to be rich in fluorine. Despite this situation, there is great opposition to the natural fluoride compound in these States because it leaves the teeth in a mottled, jagged, and brittle condition. It is an established fact that dental fluorosis is found in these communities with drinking water that contains 1 part per million and when the permanent teeth of children so raised they tend to erupt more or less chalky while in color and later tend to become pitted and stained yellow, brown, or almost black. Scientists upon careful investigation admit that the teeth are less prone to decay at an early age, but subsequent to childhood these facts are reversed. The fluoride content is then proven to be a masking operation. The teeth become infinitely more susceptible to decay and are so brittle it is difficult for any dentist to accomplish needed repair. Cognizance has been taken of these facts in the communities where the fluorides are naturally in the soil and water. It is frequently referred to as "natural |