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about 6 months for us to get together the equipment and to start the actual application.

Mr. DEROUNIAN. From your own knowledge, have you seen any results of tests as to the effects on the teeth of children and the adults over a sustained period where they have made these studies?

Mr. WILLIAM L. HARRIS. You mean in the reduction of tooth decay? Mr. DEROUNIAN. That is right.

Mr. WILLIAM L. HARRIS. Those have been published by the Michigan Department of Health and are contained in a statement of policy which has been issued by the Michigan Department of Health. I believe this statement along with some of the background has been entered in the proceedings by our health officer.

Mr. DEROUNIAN. Thank you.

Mr. BEAMER. Mr. Chairman.
Mr. HALE. Mr. Beamer.

Mr. BEAMER. Mr. Harris, I would like to ask you one brief question. The water supply for some cities, in some localities perhaps will have a certain amount of fluorine in it naturally?

Mr. WILLIAM L. HARRIS. Yes, they all have very small traces of fluorine. In the case of Lake Michigan water, it is seven hundredths of one part per million and we are raising it to over one part per million.

Mr. BEAMER. I was re-reading the very able testimony of your very able Congressman, Gerald Ford, who lives in Grand Rapids, before our committee 2 days ago. He referred to the city of Aurora, Ill., which I believe was indicated here had a natural amount of fluorine in the water that Grand Rapids does not have.

Mr. WILLIAM L. HARRIS. Yes.

Mr. BEAMER. That is your understanding?

Mr. WILLIAM L. HARRIS. Yes.

Mr. BEAMER. Now, across the State, only a short distance from Grand Rapids is Muskegon, which I understood does not have any fluoridation.

Mr. WILLIAM L. HARRIS. They did not have fluoridation of their water supply for several years.

Mr. BEAMER. They do now?

Mr. WILLIAM L. HARRIS. They do now.

Mr. BEAMER. In other words, it seems only fair from Congressman Ford's statement-and I presume that was brought out by the citizens of your community-that the people of Grand Rapids should have the same privilege to avail themselves of fluoridation, if they desire it, that the people of Aurora naturally receive from nature.

Mr. WILLIAM L. HARRIS. Yes, sir. And, of course, in Muskegon they availed themselves of that privilege and refused to go along further as a control for Grand Rapids. They wanted the same benefit for their children that the Grand Rapids people are getting.

Mr. BEAMER. Now, how much later did Muskegon do that?

Mr. WILLIAM L. HARRIS. I do not have the date, but I would assume that it would be about 4 years ago. They waited until definite results were available from Grand Rapids, showing that it had reduced tooth decay.

Mr. BEAMER. I think that is all. Thank you.

Mr. PELLY. Mr. Chairman.

Mr. HALE. Mr. Pelly.

Mr. PELLEY. Mr. Harris, have you had occasion to observe the effect of this fluorine put into the water upon the pipes of the city?

Mr. WILLIAM L. HARRIS. Yes. There has been no effect on the distribution system.

Mr. PELLY. We had evidence presented showing an advertisement, stating that it would eat through metal. I was wondering if possibly enough time has elapsed to show the chemical reaction on the pipes themselves.

Mr. WILLIAM L. HARRIS. Well, this is our 10th year and there has been no damage, corrosive condition, by any testing which we can make. We do not expect to find any.

Mr. PELLY. Is there anything in the chemical, any chemical reaction that occurs in the pipe which might cause an undue amount of fluorine content in the water to suddenly occur? In other words, could it accumulate in the pipe and then suddenly a toxic or even a lethal dose come out of the pipe?

Mr. WILLIAM L. HARRIS. NO. We followed the gradual piling up of the fluoride concentration in our water supply system immediately after adding the fluoride at our plant. We have a rather large distribution system. It contains over 400 miles of mains. It has 3 large reservoirs which can or could hold at that time 2 days' supply. By the time we got the water through all that system it took about 10 days.

Nevertheless, from that time on we have always been able to find the amount of fluoride at the end of the main, essentially the same, as that which we added. There was no buildup at any place.

Mr. PELLY. That is all.

Mr. HALE. Thank you very much.

STATEMENT OF GEORGE W. WELSH, CITY MANAGER, CITY OF GRAND RAPIDS, MICH.

Mr. HALE. Now, could we have the testimony of Mr. Welsh, the city manager of Grand Rapids?

Mr. WELSH. Yes, Mr. Chairman.

Mr. HALE. About how long will it take you, Mr. Welsh?

Mr. WELSH. Five minutes.

Mr. HALE. We have just about time to hear you.

Mr. WELSH. I just wanted to supplement Mr. Harris.

Mr. HALE. We have about sufficient time to hear you before we

recess.

Mr. WELSH. And, I want to give you a little background. Mr. HALE. You think that we should all drink fluoridated water? Mr. WELSH. I am neither a doctor nor a scientist. I have had some 25 years of public service. I will give you a little background. I served on the common council in my 10 years in the legislature; was speaker of the house of the Michigan Legislature; lieutenant governor of Michigan; came back during the depression and volunteered as city manager; later served 6 terms of 2 years each as mayor.

I was mayor when this matter was brought to us, and on the recommendation of the health authorities I recommended it to the city commission and, of course, have watched the progress ever since that time.

I think that Mr. Harris has covered the matter quite thoroughly and I would like merely to stress what the gentleman from Tennessee (Mr. Priest) stated.

During my term as mayor I served two terms as president of the United States Conference of Mayors. I succeeded Mayor LaGuardia, who served 8 years, and Mayor Kelly of Chicago, 2 years, and I presume most of you have had enough contact with the United States Conference of Mayors to know that we are rather jealous of our powers in local communities. I know that I would certainly resent having Congress say to the people of Grand Rapids, after 10 years of experience, that we can no longer do what we are now doing.

I think the gentleman from Tennessee (Mr. Priest) brought up a very pertinent point. If Congress has the right to profit, obviously it has the right to prescribe.

And, I would like to leave my testimony on just that one point.

There has been no agitation. Our people are satisfied with it. All of the testimony that you have heard and all of the facts that can be obtained show that it has been of benefit to our people and I know that, from the present demand for new schools, that it certainly has not hurt the birthrate in any way.

I think I will leave my testimony there.

Mr. HINSHAW. Mr. Chairman.

Mr. HALE. Mr. Hinshaw.

Mr. HINSHAW. I would like to ask the distinguished former lieutenant governor of Michigan what the obvious benefits from this fluoridation are. I think that is of great interest to the committee. Mr. WELSH. I think you have had the testimony of these gentlemen, the scientists and the doctors. Our people are satisfied with it. Mr. HINSHAW. Have you had a noticeable decrease in the rate of dental caries among children and adults?

Mr. WELSH. I am so informed that that is the case and I am also informed from statistics that there has been no harmful results. There has been no increase in other categories of death rates. Somebody asked the question about the birthrate. I know that it has not affected us. If it has, it has been on the multiple side.

Mr. HALE. Mr. Welsh, may I inquire, before you started this program of fluoridation, did you have any vote of the people? I presume there was a vote of the municipal officers who made the decision? Mr. WELSH. The commission, the city commission voted on it. Mr. HALE. What kind of a city charter have you?

Mr. WELSH. We have a commission-manager form-mayor and commission.

Mr. HALE. How many commissioners?

Mr. WELSH. Seven commissioners and the mayor.

Mr. HALE. And the fluoridation program was started by a vote of the seven commissioners?

Mr. WELSH. That is right. I recommended it to the commission on the recommendation of the Kent County Dental and Kent County Medical Societies; the University of Michigan Dental School, the Michigan Department of Health; the United States Public Health Service, and our own city physician and city health officer.

Mr. HALE. Has there been any popular referendum on the issue? Mr. WELSH. No; there has never been any question about it.

Mr. HALE. I presume when each commissioner comes up for reelection, any particular voter could vote against a particular commissioner because he voted for fluoridation.

Mr. WELSH. Well, I think I am the only one left that was there when it was inaugurated. It is 10 years ago, and as you know, public officials come and go.

Mr. HALE. At any rate, there is no manifestation of popular displeasure?

Mr. WELSH. It has never been an issue. I think our papers, our health officials, our people in dental and health work generally are favorable to it.

Mr. HALE. And there has been no increase as far as you know in mortality from any other disease, common or uncommon?

Mr. WELSH. The statistics I have seen show there has been no increase.

I think the point Mr. Harris made was quite significant. We wanted Muskegon, which is 35 or 40 miles away from us and also gets its water from Lake Michigan, to be a controlled city and, after seeing our experience, they declined and insisted on getting the benefits themselves. Mr. HALE. Thank you.

Mr. DEROUNIAN. Mr. Chairman, just one question of Mr. Welsh with respect to that "went." Did they "go" because they voted for fluoridation?

Mr. WELSH. No, sir; it has never been an issue.

Mr. DEROUNIAN. That is all.

Mr. HALE. Thank you very much, Mr. Welsh.

Mr. WELSH. Thank you.

Mr. HALE. This pamphlet entitled "Water Fluoridation Report of the Committee of St. Louis Medical Society" is submitted for the record.

(The pamphlet referred to is as follows:)

[Reprinted from pp. 124 to 142 of the February 1954 Missouri Medicine]
WATER FLUORIDATION

REPORT OF THE COMMITTEE OF THE ST. LOUIS MEDICAL SOCIETY SUMMARY 1. Fluorine is an element existing widely in food and water, varying in its concentration in the latter from traces to excessive amount. The fluoridation of a communal water supply entails only supplementing a deficient natural concentration. There is no way of proving by chemical test that the element, fluorine, exists in the same chemical combination in its natural concentration as results from its addition in whatever salt of fluorine is chosen. From chemical theory, however, and from all observed facts of its behavior, the inference is plain that the soluble fluoride ions are equally effective at a given concentration, however introduced.

2. There is an inverse relationship between the concentration of fluoride ion in the water supply, whether naturally occurring or the result of the supplement, and the incidence of dental caries. This has been proven by observation of inhabitants of many communities and is accepted widely by those who oppose fluoridation for reasons other than its effectiveness. The proper amount to be added as supplement for a given community is arrived at in recognition of the experience of dental caries in the school children, the naturally occurring concentration of fluoride ion in the water and the climatic conditions peculiar to that locality which influence the intake of water. The benefit to be expected can best be stated by members of the dental profession and local public health officials, and will be in proportion to the prefluoridation caries experience of that community. While fluoridation importantly reduces the incidence of caries, it does

not completely eliminate it and does not diminish the need for adequate diet, mouth hygiene and dental inspection at proper intervals. While fluordiation begins to show its effects in a year or two in school children, the maximum benefit is seen in those persons using fluoridated water from birth. The increased resistance to caries extends at least into middle life, hence it is incorrect to assert that only children are benefited by such a program.

3. At the levels of intake supplied in fluoridation programs, there is practically no storage of fluorine except in the teeth. The ideal daily amount is about one milligram in temperate or predominately cool climates and would be obtained by drinking 1 quart of water containing 1 part per million of fluoride ion. Storage elsewhere in the body has not been demonstrated with daily intakes of as much as 3 or 4 times that amount. Storage in bone apparently occurs with daily intakes substantially above 4 mg., though without demonstrable ill effect on persons who have lived all their lives with a water supply containing 8 parts per million of fluoride. A wide margin of safety is thus provided, inasmuch as intakes of fluorine about 50 percent above the ideal dose produce very mild evidences in the appearance of the teeth of such excess. These dental warnings are detectable only by expert examination and are in no way harmful to the teeth. There is no published record of any injury to the health of any person drinking natural fluoridated water with a concentration as high as 8 parts per million, nor of harmful effects at such lesser concentrations as occur naturally or are provided in fluoridation programs. No injurious effects can be found in the study of vital statistics of all the common major diseases, including cancer, or in the statistics of maternal and newborn death rates. Experimental studies on man-the most sensitive species-and lower animals confirm these evidences of the safety of a fluoridation program. Physicians practicing in areas which have had fluoridation programs for three years or more report that their experience in the treatment of the sick does not differ from their prefluoridation practices and that they do not forbid the use of fluoridated water in any case.

4. The public health and water engineering practices are relatively simple. They include selection of the most desirable compound of fluorine to be used, provision for safety measures for handlers of such chemicals, installation of feeding equipment and regular performance of chemical tests at various points in the distributing system in order to regulate the desired concentration. Annual cost in most communities has varied between 9 and 14 cents per capita.

5. An impressive roster of persons and organizations of recognized scientific standing has endorsed the efficacy and safety of fluoridation. Over 3,000,000 persons live in areas whose natural water supplies contain from 0 to 5 parts per million of fluorine. Testimony has been furnished from the physicians of 12 communities with a combined population of nearly 800,000 persons who had fluoridation programs for from 3 to 7 years as of January 1, 1953. As of August 1, 1953, 772 communities in 43 states, including 10 major cities, have fluoridation programs serving a total population of 14,000,000 persons. In the United States, such widespread adoption of any program of preventive medicine, determined upon at the local level has profound significance as to the solid merit of the proposal.

6. Testimony in opposition to fluoridation has been expressed by a numerically tiny minority of persons of undoubted scientific training and experience in relevant fields. Close examination of their testimony reveals that they do not usually question the effectiveness of the procedure but have reservations as to possible toxic effects. They do not lay down criteria by which they would judge a fluoridation program to be any safter than it has already been shown to be. In requiring an indefinite prolongation of presently established programs before extension to other areas they tend to disregard what has already been learned. There is also an active, proselyting opposition that does not represent an objective, scientific point of view at all. It seeks to defeat proposals for fluoridation by the circulation of pamphlets containing obsolete or discredited or irrelevant charges ranging from "Operation Rat Poison" to "communistic plot" themes, with a measure of food faddism for good measure. There is no authoritative expression of opposition from any religious sect nor from the representatives of any school of healing the sick which is recognized by law in Missouri.

7. There are no practicable alternatives to fluoridation of water in a city such as St. Louis. The provision of fluorine intake through tablets, milk, salt or other means has profound disadvantages peculiar to each one. Topical fluoride application directly to the teeth by skilled personnel cannot be applied universally as a public-health measure for the prevention of dental caries, insofar as it is effective, due to lack of personnel and funds. While somewhat less effective

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