Major HOBSON. Topical application of fluoride is the application of fluoride to teeth by a dentist or a trained technician.

Mr. PELLY. As far as we know now, according to the testimony that has been given, fluoride does not benefit teeth beyond the age of 9 years; is that right?

Major HOBSON. It is my opinion, from what I have read, that there is increasing evidence that it might, and in that case we are interested. Mr. PELLY. Up to now, how far?

Major HOBSON. We are not fluoridating water on any military post, camp, or station that I know of. We are, on some posts, camps, or stations, receiving fluoridated water that is purchased from local communities.

Mr. PELLY. In other words, you would be affected by this legislation?

Major HOBSON. Yes, sir.

Mr. PELLY. Thank you.

Mr. PRIEST. Just one further question, Mr. Chairman.

So far as you know, Major, is it contemplated that perhaps in the immediate or more remote future there might be fluoridation of water on military posts, if a supply is not available locally?

Major HOBSON. I would say I believe all services have had such requests, sir.

Mr. PRIEST. I believe the recommendation of the National Defense Council was that it should be done particularly where children were present on the post.

Major HOBSON. Yes, sir. That is correct.

Mr. PRIEST. That is all, Mr. Chairman.
Mr. HALE. Are there other questions?
Thank you very much, Major Hobson.
Major HOBSON. Thank you, sir.

Mr. HALE. Dr. John D. Porterfield, Association of State and Territorial Health Officers.

STATEMENT OF JOHN D. PORTERFIELD, M. D., VICE PRESIDENT, THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICERS

Dr. PORTERFIELD. This opportunity to appear before you is much appreciated. I am a physician specializing in public health and have worked in that specialty for the past 15 years. Since 1947, I have been director of health for the State of Ohio. Presently, I am vice president of the Association of State and Territorial Health Officers. In that capacity I speak to you today as the designated representative of the 53 health authorities of the States and Territories of the United States. It is these officers who carry a major responsibility within the respective States for the maintenance of standards governing municipal water supplies. They are also responsible in great part for dental health programs with particular emphasis on preventive measures in this field.

The Association of State and Territorial Health Officers has taken the following actions, by vote of the full membership, approving and recommending the controlled addition of optimum amounts of fluorides to public water supplies for the partial prevention of dental caries:

Association of State and Territorial Health Officers, Annual Meeting, 1950:

Whereas careful scientific observations since 1929 indicate that tooth decay is not as prevalent in individuals using water supplies containing sodium fluoride; and

Whereas the artificial fluoridation of public water supplies was experimentally instituted and has been under continuous study since 1945; and

Whereas these studies have shown that there is no menace to the teeth of the persons using 1 part per million of sodium fluoride; and

Whereas State and Territorial dental health directors have endorsed in principle the fluoridation of public water supplies as a partial protection against dental caries: Therefore be it

Resolved, That the Association of State and Territorial Health Officers recommends, where the medical and dental professions concur and where communities can meet the standards of the State health authorities that all State health officials approve the artificial fluoridation of public water supplies for the partial control of dental caries.

And in its annual meeting of 1951, the following recommendation was made:

That the State and Territorial health departments be urged to conduct more intensive promotional and educational programs designed to bring the benefits of water fluoridation to all communities as soon as possible.

In its annual meeting in 1952, the following recommendation was made:

That the State and Territorial Health Officers Association, in view of the overwhelming evidence in favor of water fluoridation, reemphasize that the full benefits of this public health measure should be brought to all communities as rapidly as possible, and that association members aid communities in developing fluoridation programs by providing effective information, dental and engineering assistance.

And in its annual meeting in 1953:

It is recommended that the Department of Health, Education, and Welfare develop jointly with the State and Territorial health officers and their dental directors a plan to further expand, emphasize, and distribute information concerning the values of fluoridating water systems deficient in fluoride.

In addition to these formal actions taken by the association, virtually all individual State health authorities have established procedures for the approval of community fluoridation plans.

Rather than review the scientific evidence which formed the basis for these actions, I would like to describe the responsibility of a State health officer regarding the use of newly developed procedures for the prevention or control of disease.

A State health officer is charged by law with the protection of the public health and the prevention and control of disease. When any procedure is purported to provide health benefits he must carefully evaluate its effectiveness, safety, and practical worth.

This serious responsibility is one which leads to the development on the part of a State health officer of an extremely conservative attitude and a very critical point of view with respect to new advances in health practices.

It is within this framework of responsibility that the association examined the scientific evidence and, recognizing its responsibility, not only to safeguard the public health, but to promote procedures designed to improve the health status of our citizens, has seen fit to endorse and recommend controlled water fluoridation for the prevention of tooth decay. The association took due cognizance of the

claims that the procedures would be a hazard to health and found them without basis in scientific fact.

Therefore, the Association of State and Territorial Health Offices is firmly of the opinion that the passage of H. R. 2341 would not be in the public interest and, furthermore, its enactment would in fact be a contradiction of the overwhelming scientific evidence supporting water fluoridation as a safe and effective preventive of dental caries. Mr. HALE. Are there any questions of Dr. Porterfield?

Mr. Beamer?

Mr. BEAMER. Dr. Porterfield, I have received letters from the Indiana Dental Society, which substantiates the statement you have made, and I take it all the States have organizations that belong to your association?

Dr. PORTERFIELD. No, sir, the Association of State and Territorial Health Officers is made up exclusively of the State health officer of each State and Territory.

In each of those States and Territories, there is a dental association. And much as Dr. Knutson described his use of advisory councils of experts, so, too, State health officers, in coming to these decisions of policy, confer with the dental health councils when it is a dental matter and with other people who have experience or ability in the field in question.

Mr. BEAMER. The reason I make this statement is because I have received no letters from the Indiana State health officer, although I have received numerous letters from the dental societies and from individual dentists. I am wondering whether or not the State health officer confers with the various dental societies.

Dr. PORTERFIELD. It is my understanding that he does, sir. I am personally familiar, to some degree, with both the State health officer and with his methods of operation in that State, and that is his practice. And I know personally that he has endorsed, as the chief health officer of Indiana, the fluoridation program.

Mr. HESELTON. Doctor, I notice that beginning in 1951, and following it up in 1952 and 1953, at the annual meeting, the association voted to urge the State and Territorial health departments to conduct a more intensive promotional and educational program. In effect, that is the same sort of a vote as taken in 1952 and 1953.

Will you describe briefly the type of program that you were urging? Is there any literature that was provided for distribution? If so, of what type was it, and how widely disseminated?

Dr. PORTERFIELD. The association, as such, sir, does not have funds to carry out operations of any nature as an association. It confines itself pretty much to its annual meeting and conferences of that type. However, each of the individual State health officers has, in keeping with his resources and interest, developed things. A number of the States have developed educational or informational material on this. question of fluoridation.

They have also availed themselves of the resources both of the Public health service and of the American Dental Association. Several of them, I know, individually have collected a kit of their own by personal solicitation from the various authors who have published in this field, both pro and con, in order to determine for themselves what their policy should be, and then to promote that policy, that recommendation, in the form of health education within their State.

Mr. BEAMER. What about the situation in your own State of Ohio? Do you have such a kit available?

Dr. PORTERFIELD. Yes, sir. I don't have it available with me, but such could be sent you.

Some of those would be duplicates of items you could receive from other associations, but it is our particular collection in Ohio that we use when a community expresses interest in considering this question Mr. BEAMER. If you will do that, I think it will be very helpful. Now, in addition to that, do you know whether or not the State authorities send any agents or representatives around to the communities, either to explain what the State official position is or to attempt to stir up interest in introducing fluoridation of the local public water supply?

Dr. PORTERFIELD. Yes, sir. That would be in keeping with our general operation. Most State health departments devote a considerable amount of their activity to educational activity; and in that connection both dentists and health educators from the various departments would travel in their State to communities, usually but not always on specific invitation of the local dental societies or the local medical society or the local board of health or citizens health council.

If I may etend my remarks in xthat connection, however, this question and would like to have information, when such requests come in from the community, the State health department sends people to provide that information. There is no gainsaying the fact that when questions are not raised locally, the health educators and the dentists and such people from the State health department may, in their visits to local health departments, in discussing their overall programs, suggest to them that one item in their program which they have not considered is fluoridation.

If I may extend my remarks in that connection, however, this matter of promotion of fluoridation is within controlled limits. The State health department in Ohio and I think, in most other States, reserves the right to disapprove a community's desire to fluoridate water if the engineers of the State health department have determined that its waterworks system and the personnel operating such are not competent to provide a control program.

Mr. BEAMER. Has that right ever been exercised, to your knowledge, in Ohio?

Dr. PORTERFIELD. Yes, sir; not formally by the State health department council action, but we have advised one or two small communities that until they develop a proper water supply system and a properly trained operator, we can't recommend to them that they consider the question.

It has never gone further than that.

Mr. BEAMER. Thank you, Doctor. That is all.

Mr. HALE. Mr. Pelly?

Mr. PELLY. Doctor, I would just like to ask you if in the State of Ohio you have had local votes in communities on whether they should or should not put in fluoridation?

Dr. PORTERFIELD. Yes, sir. There has been one that is well known, in the city of Cincinnati.

Mr. PELLY. That is the only vote you know of?

Dr. PORTERFIELD. That is the only popular referendum of which I know, yes.

Mr. PELLY. I asked Dr. Knutson before you came on the stand as to whether or not teams of Federal workers had gone around to promote fluoridation, and you may have heard a gasp from certain individuals, who I think were proponents of the bill, indicating that there was some doubt in their minds as to whether or not the public health service had done it or not. Do you know in the State of Ohio whether or not any State Public Health Service officials have gone around to promote fluoridation?

Dr. PORTERFIELD. To the best of my knowledge, sir, Public Health Service officials have not, of their own volition, come into the State of Ohio and taken any community action. It depends, I think, a little bit on the context of the question asked. When the city of Cincinnati was considering the question of fluoridation, the city health officer, the health council of that city, the health federation, so-called, and certain other groups down there who were interested, sought the help and advise of the State health department.

Our dental health chief and others, including myself, visited Cincinnati, indulged in public forums in which both sides of the issue were debated, both on television and in public meetings; and during that time, which extended over several months, it may well be, although I don't know this as a specific fact, that we had called in an employee of the Public Health Service from the regional office to travel with us or to advise us on certain material that was not immediately available at first hand to us. So it is possible; but not directly from the Federal Government to the community; not in Ohio.

Mr. PELLY. I can understand how a misunderstanding might have arisen, and that possibly some local health authorities or State health authorities had called in regional Public Health Service members to travel to some community with them.

Dr. PORTERFIELD. That is right, sir.

Mr. PELLY. That is all. Thank you, Mr. Chairman.
Mr. HALE. Thank you very much, Dr. Porterfield.

The last witness will be Dr. Harry Jordan, secretary of the American Water Works Association.

STATEMENT OF HARRY E. JORDAN, SECRETARY AND CHIEF EXECUTIVE OFFICER OF THE AMERICAN WATER WORKS ASSOCIATION, BY DAVID AULD, DIRECTOR, AMERICAN WATER WORKS ASSOCIATION

Mr. AULD. Mr. Chairman, Dr. Harry Jordan was unavoidably prevented from coming to this hearing.

He asked me to present his

paper to you.

I am David Auld, a director of the American Water Works Association. [Reading:]

My name is Harry E. Jordan. I have the honor to present to your committee comments in opposition to the enactment of H. R. 2341 (Wier), to protect the public health from the dangers of fluoridation of water.

I have for more than 50 years been concerned with the production and distribution of safe water supply. I am a graduate of Franklin College, holding degrees of bachelor of science and doctor of science in chemistry. I am a life member of the American Society of Civil Engineers, the American Public Health Association; and an honorary member of the American Water Works Association and the New England Water Works Association. I have been since 1936 the secretary and chief executive officer of the American Water Works Association.