and that there will be a follow up to be certain that they are received by the committee.

Now, just one other question, and I do not want to prolong this dis

cussion.

On page 2, you made this statement:

Fluoride is a "trace element in nutrition" and water is a natural source of this nutritional element.

Will you just very briefly break that phrase down into a layman's language.

Dr. Dory. Yes. It means just exactly what it says. "The trace element" means one which ingested in a very small quantity, is considered a trace; an element, of course, in nutrition means that it is a factor important in nutrition. The reason that was put in quotes was that is practically the language used in the Ad Hoc Committee report of the National Research Council.

Mr. PRIEST. Thank you, Doctor. That is all, Mr. Chairman.
Mr. HESELTON. Mr. Chairman.

Mr. HALE. Mr. Heselton.

Mr. HESELTON. Doctor, I regret that I was unable to get here in time to hear all of your statement.

I would like to inquire whether you have discussed the effect and determined the effect on people beyond childhood; that is, upon people who are over the period of time that has been suggested do benefit by taking fluorides in any form?

Dr. Dory. That was discussed only incidental in my formal presentation here.

It is included in the vital statistics. In other words, the measurements in various population groups of the amount of different types and degrees, which will include the aged as well as the young, and to that extent my reference here to vital statistical data do apply to such individuals.

I may say there is further additional reference both to the dental benefits to children and to the adult, and with respect to the safety to the adult.

One further point I referred to here in that connection was the experience of the Southbury Training School in Connecticut, where they have had fluoride-bearing water, used that for a number of years, and where it has been used by both the inmates and the employees. In that institution there are some who are quite elderly, and in very extensive medical examination of most of those individuals they found no evidence of injury to those particular individuals.

With reference to the dental benefits, the dental benefits which are obtained and are obtained during the period of childhood, that is, while the teeth are developing, are retained into adult life. There have been studies made, comparing 40-year-olds, for example, who have lived their entire life in Colorado Springs, drinking Colorado Springs water, where the water contains about two and one-half parts fluorides; comparing those 40-year-olds, that is their mouth conditions, with those of 40-year-olds in Boulder, Colo., where the water contains a very low percentage of fluorides.

Now, it has been found that the same ratio of benefits, dental benefits, observed in children is still observed in those adults and that

those adults who have lived in that fluoride area, that is, Colorado Springs area, have retained a larger number of teeth than have the individuals who lived in the area without fluoride. There have been rather extensive studies with adults.

Mr. HESELTON. You have anticipated the second question I wanted to ask you.

My attention has been called-first, were you here yesterday?
Dr. DOTY. Part of the time; yes.

Mr. HESELTON. Did you hear Dr. Dean testify?

Dr. Dory. Yes.

Mr. HESELTON. My attention has been called to the fact that he testified as to the prophylactic effect of fluoridation up to the age of 9 years only while there has been other testimony, I am told, that would show that the number of decayed teeth, in both Newburgh, N. Y., and Grand Rapids, Mich., among the individuals of the age 14 exceed that in communities where there was no fluoridation. Would you comment on that?

Dr. Dory. Yes, I would be very happy to.

You are correct, of course, in saying that he testified with regard to children up to the age of 9 in those areas where fluoride is merely being added, because that is the maximum length of time that it has been added in a given community. However, Dr. Dean also testified with respect to very extensive studies which he and his colleagues made some years prior to that in which they observed primary 12and 14-year-old children who had lived their entire lifetime in an area where the water, incidentally, contained fluorides. So actually he testified both with respect to children up to 9 years of age, and with respect to children at an older age.

Now, what Dr. Dean pointed out was that, of course, where fluoride has been purposely added for a period of 5 years, you can only compare that then with 5-year-olds; in a community where it has been present all of the time, you see, because only the 5-year-old children in this one community will have used it for 5 years.

The 10-year-old children have only used it during the last 5 years of their lives.

Now, whenever fluoride has been added for a period of 9 years, there will be children up to 9 years of age who will have used that water throughout their entire lifetime. The 10-year-old age group and the 12-year-old age group would only have used it during the last 9 years of their lifetime.

Now, when you compare then the appropriate age group in a city which is receiving controlled fluoridation, with that age group in the area where the fluoridation has been there, as I say, incidentally, you find identical results; but obviously it is not possible to compare 12and 14-year-olds in Grand Rapids, for example, with 12- and 14-yearolds in Aurora, Ill., for the reason that the Grand Rapids experiment has not been proceeding for 12 to 14 years.

Mr. HESELTON. You say that those studies have been made?

Dr. DOTY. Yes, sir.

Mr. HESELTON. What conclusions were reached?

Dr. DoTY. You mean from the studies in those areas where the water incidentally contains fluorides?

Mr. HESELTON. In comparison with the others.

48391-54-20

Dr. Dory. In comparison with the others. They have found that the results, when they compared those age groups or those children who had received the water throughout their entire lifetime, were the

same.

Mr. HESELTON. In your annotations, have you made reference to those studies?

Dr. DOTY. Those studies will be referred to in Dr. Dean's report. It is referred to in there.

Mr. PELLY. Mr. Chairman, may I ask another question? I believe the gentleman has yielded the floor?

Mr. HALE. Mr. Pelly.

Mr. PELLY. Doctor, is it true that fluorine, so far as certain industries are concerned, contaminates the water so that it causes great damage, almost put certain industries out of business. Is that not true? We had a query on that. We have to have pure water for paper manufacturers, for instance.

Dr. Dory. I am not sure that I know the direction of your question. I think, however, that it relates to whether or not there is an ill effect on industrial use of the water.

Mr. PELLY. Discoloration of paper, and other products that are manufactured.

Dr. DoTY. May I comment in that regard, that that was one of the things that was given early consideration before any pilot study project was inaugurated, and there has been no evidence that the use of water containing 1 part per million fluoride has an adverse effect or adversely affects any industrial processes.

I may say for example, that many industries have for years used water containing considerable more fluoride than this particular amount. As a matter of fact, there was a public statement of one of the large breweries of St. Louis just a short time ago saying that they had no objections to controlled fluoridation of the St. Louis water supply.

Another industry, or other industries have anticipated this problem. The baking industry some years ago investigated the possible effect of fluoride upon the use of yeast and other products in the baking of breads. Other industries have also anticipated the same problem. They wanted to assure themselves that the use of this water would not complicate their procedures.

A very extensive review of that consideration appeared in the Journal of the American Waterworks Association about, I believe, 6 months or a year ago.

We know of no industry which will be handicapped by the use of this water.

Mr. PELLY. Thank you.

I would like to ask you as to whether or not it is possible to put fluorine into milk, for example, so that it would be possible for those who, on religious basis, could order either fluorine-free milk, or those that wanted fluorine and where it was recommended by their dentists, could buy it if they wanted to and not impose it upon all of the people who have objected to it.

Dr. Dory. May I be permitted to comment rather extensively on that point? I will be very happy to do so.

Mr. PELLY. I think it should be in the record, Mr. Chairman.

Dr. Dory. I will be glad to do it.

Let me say first that extensive consideration has been given to the possibility of adding fluoride to one or a number of food products. Now, one of the particular points that I made in the early part of my statement was the fact that water is the only vehicle which has been demonstrated to be a safe method of providing dietary fluoride. If that were not true, it would be possible to add fluoride, to supplement other materials with fluoride, and allow people to obtain it in that particular way.

I would like to point out that the quantity of fluoride required by the child-he must receive a certain amount in order to receive the benefits he should not receive an excessive amount in order to eliminate the possibility of unesthetic effect of the mottling of the teeth. Consequently, the amount which the individual obtains must be kept within fairly narrow limits.

There is quite a margin of safety, but still it must be kept within fairly narrow limits.

Now, the amount of water which an individual ingests is more nearly constant each day than any other single food element. That is one factor to be considered.

A second factor to be considered is that we simply do not know whether fluoride added to milk with have the same beneficial effect which will be attained from fluoride in the water.

Now, there are certain theoretical chemical reasons for anticipating difficulties there.

That is due to the fundamental fact, that we simply have no demonstration that this addition of fluoride at the same level to milk will produce the same dental benefits which will be produced, or which are always observed, when fluoride is added to water in this particular concentration.

Now, may I also comment on the subject of so-called mass medication?"

I think obviously, for example, when you are enacting legislation you have to accept a certain definition in order that you can enact legislation which applies just to a particular thing and not to everything else.

So, we must also arrive at some sort of a commonsense definition of medication.

Now, when a doctor prescribes for you some drug or material to be used in the treatment of a specific disease, I think we would all agree that that is medication. In other words, when I drink orange juice to obtain vitamin C, or when you do, you are in effect using a material to prevent the development of a disease, because a lack of vitamin A may lead to a condition which in the gross symptom is referred to as scurvy, and so the drinking of orange juice then is the taking in of material which prevents the development of a disease.

When a child drinks milk or other food, which contains vitamin D, that child is being protected by the ingestion of that food material from the development of a disease which in its gross form is known as rickets.

When individuals eat ordinary food containing vitamin B1, they are preventing the development of a disease which in its gross manifestation is referred to as beriberi. So that you can say that every nutrient which is required by the body is for preventing disease.

Now, if you wish to extend the definition of medication to every food which is ingested, then I am perfectly safe in saying that that is medication; but if you wish to accept a definition for medication which excludes the ingestion or nutrient materials, for the benefit which they provide to the body, then you must, of necessity, exclude fluoridation from the concept of medication.

Mr. ROGERS. Mr. Chairman. Will the gentleman yield?
Mr. PELLY. I will yield to the gentleman.

Mr. ROGERS. I am glad you referred to orange juice, because I come from the State of Florida and I am glad to hear you say that milk and orange juice are safe.

Mr. PELLY. I am sorry that the gentleman from Florida was not here earlier, because I have already referred to the benefit of orange juice and expressed a disappointment that we do not still have the orange juice dispensed to us regularly by the delegation from Florida. Mr. HALE. As there any further questions?

Mr. HESELTON. Mr. Chairman.

Mr. HALE. Mr. Heselton.

Mr. HESELTON. Doctor, in connection with your bibliography, also Dr. Dean's; and some other witnesses who have testified, may I inquire whether copies of each of these articles to which references have been made are available to the committee?

Dr. DoTY. Some of them have been made available, but not all of them. In the event that the committee wishes, I am sure that we can make such articles available to the committee.

Mr. HESELTON. I expect that the staff can get whatever we need from the Library of Congress.

Mr. HALE. Are there any further questions?

Mr. HARRIS. Mr. Chairman.

Mr. HALE. Mr. Harris.

Mr. HARRIS. Dr. Doty, I have not had a chance to look over your brief statement, and regret that I did not get here in time to hear you deliver it. You may have covered this. You did, I notice, refer to the amount of fluorine in water by artificial means.

Dr. Dory. Yes.

Mr. HARRIS. Now, it is true, is it not, that some areas of the country and of the world have more natural fluorine in the water than they do in other areas; is that right?

Dr. Dory. They naturally contain higher amounts. It is all the same fluorine, because, after all, man does not create fluorine. All of the fluorine which is available is that which occurs in various deposits in nature, but some water naturally contains higher amounts of fluorine than other waters. Yes, you are correct.

Mr. HARRIS. Now, the natural fluorine is the same as the fluorine that you put in by artificial means?

Dr. Dory. Yes, sir; that was covered quite extensively in the state

ment.

Mr. HARRIS. Yes.

Dr. Dory. And was directed to the attention of the members that some very eminent chemists have filed statements for the committee for use in that regard.

Mr. HARRIS. Yes, I appreciate that and the purpose in referring to it is to get your comment on a statement that was made that in cer