FLUORIDATION OF WATER SUPPLIES

§ LORD COHEN OF BIRKENHEAD

My Lords, I should like at the outset to make two points. The first is that nobody, certainly including those who are protagonists in the matter of fluoridation, would in any way impugn either the sincerity or the integrity of the noble Lord who has introduced this Motion. What we do impugn is his judgment, and I propose in a few moments to apply myself to that issue.

The second point which I should like to make is that, in a measure, I have an interest in this subject because I was Chairman of the Standing Medical Advisory Committee of the Ministry and of the Central Health Services Council during much of the relevant discussion on the question of fluoridation. It should be remembered that it was no sudden flash-in-the-pan decision on the part of the Ministry to recommend fluoridation to local authorities. It was, indeed, seven years after fluoridation had been commenced in the United States and Canada that the Medical Research Council recommended that a British Government commission should visit the United States and Canada and report on whether fluoridation did, in fact, delay the onset of dental decay, and whether there were any evident general health hazards associated with the fluoridation of water supplies. They returned in 1953, giving answers which were quite specific to both those questions: that fluoridation did delay the onset of dental caries and, secondly, that there was no evidence that there were any 106 hazards to general health. But they recommended that there should be special studies in this country, which were indeed carried out, and they were reported on in 1961.

This, in fact, is where I come in, because in 1961 the Standing Medical Advisory Committee recommended to the Minister, on the basis of all the available reports, that fluoridation should be adopted. The Minister then, with appropriate caution, said, "Be that as it may, we must be certain that there are no general hazards to health". So a Joint Committee of the Standing Medical Advisory Committees of England and Wales and of Scotland was appointed, with myself as Chairman, to examine this matter, and we examined it with great care. We studied intensively not only the report of those who had carried out the investigations in this country, but also the reports of the commissions which had been held in Ontario, New Zealand and elsewhere. We came to this conclusion: there was no evidence to support the view that fluoridation carried any hazard to general health in a concentration of one part per million. I agree that that evidence is based essentially on negative findings, but your Lordships will be aware that no experiment or investigation can ever be devised to prove a null hypothesis. What you have to do is to give the facts a chance to disprove it; and the Committee found: the weight and consistency of well-founded facts carried the firm implication that fluoridation should be generally adopted in view of its considerable benefit to dental health. This advice, which was given to the Minister, was endorsed by the Standing Medical Advisory Committee and the Central Health Services Council.

I am grateful to the noble Lord, Lord Douglas of Barloch, for having provided me with a reference, but it reads a little differently, as I understand it, from what he quoted. The pamphlet says: The number of scientific papers bearing on the safety of fluoride —not on fluoridation, but on the safety of fluoridation— is prodigious; by 1958 the World Health Organisation's expert committee on water fluoridation estimated that the number approached 3,000 over a period of 20 years". But the 3,000 referred to the papers on the safety of fluoridation, and not on 107 fluoridation itself. The Ministry's pamphlet goes on to say that: any reports on the safety or efficacy of fluoride will always receive the closest attention. There is no truth whatever in the allegation that the Government ignored reports unfavourable to fluoridation in deciding to encourage its introduction. All such reports have been carefully evaluated. What the noble Lord, Lord Douglas of Barloch, did not tell your Lordships was the view of the expert committee on fluoridation of the World Health Organisation. They said: The effectiveness, safety and practicability of fluoridation as a means of preventing dental caries is now established. All the findings fit together in a constant whole that constitutes a guarantee of safety…a body of evidence without precedence in public health procedures.

§ EARL WALDEGRAVE

My Lords, will the noble Lord give a reference for these various pamphlets? I believe that is not in one of these published pamphlets.

§ LORD COHEN OF BIRKENHEAD

No, my Lords. This is, in fact, in the World Health Organisation's pamphlet itself.

I shall have to refer to certain specific points which the noble Lord, Lord Douglas of Barloch, has made. I do not propose to deploy all the pros and cons of fluoridation this afternoon. They have, indeed, been reiterated on several occasions in Parliament, and to consider them in detail would take many days. Indeed, in the High Court of Dublin in 1963 there was a hearing on this very subject which took 65 days. In that case a lady challenged the right or the constitutional validity of what was called the Health (Fluoridation of Water Supplies) Act 1960, and many expert witnesses were called on both sides. No one, I think, would deny the great distinction of Mr. Justice Kenny who tried the case. He cannot be accused of the partiality which is sometimes attributed to doctors in respect of fluoridation. Perhaps I may therefore read one or two excerpts from his judgment after hearing evidence for 60 days. In paragraph 35 he says: Having heard the evidence and read the literature which it was agreed I should read, I am satisfied that the fluoridation of public water supplies at a concentration of one part per million will not in our temperate climate be dangerous to anybody—old, young, healthy 108 or sick. I am also satisfied that there is no reasonable possibility that it may involve an element of danger or risk to life or health to any of the citizens of this country. Then he goes on to say in paragraph 36: It would, I think, be sufficient for the purposes of this case to say that the plaintiff has not proved that the fluoridation of public water supply is dangerous, but I do not think that I should so confine myself. The evidence given on behalf of the plaintiff at the earlier stages in this case received wide publicity"— that is, the evidence against fluoridation— while the far more compelling evidence for the defendant received little public notice. It is possible that the evidence for the plaintiff, some of which was of a sensational character, may have created public uneasiness. Let me say, then, that I am satisfied beyond the slightest doubt that the fluoridation of the public water supplies in this country at a concentration of one part per million will not cause any damage or injury to the health of anybody—young, old, healthy or sick—who is living in this country, and that there is no risk or prospect whatever that it will. The evidence on which I base this view consists of a number of items each of which is conclusive; when taken together they are compelling. Then, my Lords, Mr. Justice Kenny proceeded to review the evidence in great detail (this is published, and is available to any Member of your Lordships' House), and he also expressed his view of some of the witnesses. He spoke in the highest terms of those who had given evidence for the defence—in fact, he rebuked counsel for having imputed ulterior motives to one of the expert witnesses for the defence—but he had some observations on those who had given evidence for the plaintiff, and I will quote what he said because many of the names which are quoted by the learned judge are those given in the pamphlet issued by the National Pure Water Association as critics of fluoridation. This is what the learned judge said: I reject the evidence of Professor Gordonoff, of Dr. Rozeik, of Dr. Waldbott and of Dr. Dillon. There was a marked note of fanaticism and passionate conviction about their evidence. I got the impression that they were determined at all costs to make a case against fluoridation. The learned judge went on to say, referring to matters which the noble Lord, Lord Douglas of Barloch, has quoted in relation to fluoride and goitre: The evidence of Professor Benagiano and Dr. Fiorentini"— 109 both of whom are critics of fluoridation noted by the National Pure Water Association— that there is a relationship between the presence of fluoride ion in the drinking water and the high incidence of goitre, together with an unusual basal metabolic rate…is not, in my opinion, reliable. Of two others, he said that their evidence was such that, while they were impressive witnesses, he was unable to accept their evidence in relation to goitre. They were Professor Steyn and Dr. Sinclair, who conceded during cross-examination that many of the ill-effects which he mentioned would not arise when the concentration of fluoride ion in the water was one part per million.

My Lords, you may think that that is only an individual judgment, but there have been several such judgments. I have quoted this one at length because it was suggested in another place in July, 1963 (column 686 of Hansard of July 17), that there should be a judicial inquiry. But this was a judicial inquiry in a court of law, where evidence was given on oath. And the inquiry was conducted by a judge who was skilled, not only in the assessment of evidence but also in determining the credibility of witnesses.

§ VISCOUNT STUART OF FINDHORN

My Lords, may I ask whether the judge was skilled in this question of the chemical action?

§ LORD COHEN OF BIRKENHEAD

The judge heard expert witnesses on both sides. I suppose it may be said that those who are most skilled in this field are the most suspect, because those who are most skilled in this field have supported fluoridation. However, in this country it was suggested that there should be a judicial inquiry, and it is not uncommon for matters of expert decision to be taken by judges in a court of law, with appropriate witnesses.

§ VISCOUNT STUART OF FINDHORN

I myself supported it in the Scottish Office.

§ LORD COHEN OF BIRKENHEAD

I am coming to that, and the noble Viscount will, I am sure, approve of what I am about to say.

Let me refer now to what was said by another judge in New Zealand—and it is quoted in a judgment of the Judicial 110 Committee of the Privy Council delivered on July 22, 1964, to which I propose to refer later; but I should like to quote this judgment as another illustration of the judicial approach. The Judicial Committee said that the action came before Justice McGregor, and he examined the evidence with meticulous care. At one stage of his judgment, he said this: I have heard considerable evidence in the matter, and I must say at the outset that I have never hitherto experienced evidence more impressive and cogent than that of the defendant, establishing that it is, to use a neutral expression, most desirable that fluoride should be added to the water. Later in his judgment, he said: In the present case, I was satisfied, on the evidence, (1) that there is a high incidence of dental caries in New Zealand generally; (2) that there is almost a complete absence, or at least a high deficiency, in the fluoride content of the natural well water supply at Lower Hutt;"— which was the place in question— (3) that the absorption of fluoride has a substantial effect in reducing the incidence of dental caries, especially in young children; (4) that there are no deleterious or toxic effects on the human body from the absorption of fluoride, more emphatically in the minute proportion of one part to a million; (5) that any surplus fluoride taken in the body is without harmful effects and is excreted; and (6)"— a point which I shall deal with later— that tablets or other vehicles for the taking of fluoride are unsatisfactory in that the required regularity with children would not be achieved, and that natural water is the only satisfactory vehicle. My Lords, what are the established facts? The first is that dental decay is a major and a serious national problem. In 1964, 6¼ million permanent teeth of schoolchildren were filled and 1 million were extracted. Now, fluoridation diminishes, reduces, the level of decay by about 50 per cent. It is wrong to suggest that it will not do so in adults who have started taking fluoridation at birth, or during the mother's pregnancy. There is increasing evidence about this; and, if the noble Lord is in any doubt, I can provide him with some. Here, for example, I have a study from one of the places where fluoridation was introduced early in which, at the ages now of 12 to 18, there are 50 per cent. fewer decayed, missing or filled teeth, and 62 per cent. fewer teeth needing attention.

§ LORD DOUGLAS OF BARLOCH

My Lords, would the noble Lord say what this comparison was made with? Fewer than what?

§ LORD COHEN OF BIRKENHEAD

Fewer than occurred in an area which was comparable except in relation to the natural fluoride of its water supply. The comparison was between Aurora and Rockford. Both these places are in Illinois, and the noble Lord may have visited them, as I have. Again, there is the comparatively recent Grand Rapids report which shows that this trend continues. The point is that before 1945, except in those areas of natural fluoridation, there was no attempt to increase the fluoride content of water supply, and so one could not expect that in those areas there would be less decay. It is less use starting after a child has been without it for a year or two years; the beneficial effects may not be seen. What I have said about the seriousness of the position is this. It is not only the discomfort which is given to children: it is the fact that there is the problem of providing sufficient dentists to deal with, this matter—and by the use of fluoridation there would be a saving of not less than 500 whole-time practising dentists.

The second point I would make—and it is of prime importance, because the noble Lord kept referring to medication—is that fluoride is not a drug. It is present naturally in many water supplies; and in some, in far higher quantities than the proposed one part in a million. It is adjusted to a level of one part per million. It does not affect the taste, colour or odour of the water. What it does is to prevent dental decay. And it prevents: it does not cure. Medicinal treatment, medications, tend to cure disease. Fluoridation does not cure. Once decay is established, fluoridated water will not cure it. I agree with the noble Lord that fluoridation is not the only measure that can be adopted. It so happens that it is very important; but there are other measures.

Brushing the teeth after meals (and preferably five minutes after meals), in order not to allow the development of lactic acid from carbohydrate residues, is most important. The eating of some coarse foods, such as apples, carrots, celery, at the end of a meal to remove the debris which is forming around the teeth is also an 112 excellent measure. To deny children sweets between meals is of great importance. But a six-monthly visit to the dentist is also important in order that there might be seen the incipient evidences of dental decay, which can be controlled. But how many parents can enforce such a régime on children? How many parents themselves carry out such a régime? Moreover, there are far too few dentists to supervise this kind of régime on the lines suggested.

The next point that is established is that fluoridation is safe. Unfortunately, there has been serious reaction to emotional and misleading propaganda. In Charlotte, North Carolina, for example, where the local authority announced that it would fluoridate the water supplies on April 1, 1949 (why April 1 was chosen I do not know), there flooded into the town hall during the ensuing week complaints that people were suffering from indigestion, from skin irritation; that cutlery was stained; that photographic plates were blurred; that goldfish were dying; that flowers were fading, and so on. The fact is that the corporation did not fluoridate the supplies on April 1, 1949. They postponed fluoridation, and then introduced it several weeks later without any public announcement—and there were no complaints.

Again, those of us who practise medicine know perfectly well of the fallacies of the post hoc, propter hoc argument. The fact that a person has indigestion after fluoridation does not mean that it is due to fluoridation. There are, alas! thousands upon thousands of people who suffer from indigestion, or who have a skin complain in areas whether the water is not fluoridated. And this is further evidence of post hoc, propter hoc.

I should like to return to two matters raised by the noble Lord: Mongolism and goitre. I shall not deal in detail with goitre, because I have already referred to it. In regard to Mongolism, I myself saw the Rapaport papers and I wrote to Dr. Rapaport (this, I may say, was on June 23, 1964), and asked him whether he would explain certain features of his results which I found somewhat misleading. I received no direct reply from Dr. Rapaport but I had an indirect reply from a friend of mine (who, incidentally, is a critic of fluoridation) who had met him. The letter was marked "Private", 113 but the gist of the matter is that Dr. Rapaport refuses now to discuss his findings with anyone, because he says that he has been subjected to undue criticism.

What the noble Lord did not mention was that Dr. Berry, who is one of the medical officers of Health, published a paper showing that in the areas which Dr. Rapaport was discussing the incidence of Mongolism was far lower than in any area where there had been a proper investigation of Mongolism; and the incidence of Mongolism in this country was, in many areas, at least twice as high as that found by Dr. Rapaport in fluoridated areas. The noble Lord mentioned the county of Essex. The fact is that the difference in the incidence of Mongolism where the supply is from 0.2 to 4 parts per million and in areas with less than 0.25 part per million is such that it is not in fact statistically significant. Dr. Berry's paper is available to anyone, and might be read with considerable profit and interest. If it be true that with 0.3 part per million, goitre appeared in Japan, why is it not appearing all over this country where much of the water has more than 0.3 part per million? Why not in every European country where much of the water has more than 0.3 part per million? The answer, with respect, is that of course if an observation of that kind contradicts all other findings, one must view it with great care and scepticism.

Let me make this further point. There is no practical substitute for fluoridation. I know that the giving of fluoride tablets has been advised; but this means irregularity in their administration. We know how parents behave with measures of this kind. After all, a significant percentage of mothers did not take up many of the food supplements given them during the war: moreover, to have bottles of fluoride in your cupboard means that you run the risk of inducing some toxic effects. Local application of tin fluoride needs dental application and is not as effective; and it costs 300 times as much. Fluoride cannot be conveyed in milk or food. Dentifrices are not very satisfactory, but research goes on: pyridoxine, phytates, molybdenum, zirconium and other substances are being tried; but the conclusion is that there is no practical substitute for fluoridation. It is the only available safe, feasible and 114 economic method of benefiting the public. One must accept that in discussing its ethical aspect.

The noble Lord, Lord Douglas of Bar-loch, mentioned that if fluoride is introduced there will be no practical alternative to consuming fluoridated water for those living in the area. I agree with the noble Lord; I do not think there is an effective substitute. The use of bottles of non-fluoridated water; obtaining supplies of water from neighbouring sources; the use of de-fluoridators—none of these alternatives has yet been established. Dr. Fremlin, Reader in Physics at Birmingham University, has devised something of the kind; but it is not yet practicable. But to use the words "mass medication", or "medical treatment" seems to me wholly inapplicable to this situation. It will not be clarified by copious references to dictionary meanings of drug, nutrient, medicine, prevention and cure. There is, indeed, too great a current tendency to seek to persuade people by describing a situation, which is difficult to comprehend because of its complexity, by some meretricious phrase or label which carries implications that cannot be justified by the facts.

The issue here is not a question of semantics and is not affected by labels. To call fluoridation "mass medication" obscures the issue. The issue is that of deciding whether adjusting the level of the natural content of a natural constituent of water, in the interests of children, who, as a result have better teeth now and when they grow up, is justified, even if a proportion of citizens will derive no immediiate benefit. And remember that it is the children who will be benefited at this stage, and these children cannot themselves take the initiative. They cannot protect their own health and their own teeth. They are dependent on the knowledge, thought and care of their parents; and often it is those children who are most in need who have the least degree of parental care.

It has been said that fluoridation renders water impure. This is the stand of the National Pure Water Association, of which the noble Lord, Lord Douglas of Barloch, is President. But may I refer once again to the judgment of the Lords of the Judicial Committee of the Privy Council, delivered on July 22, 1964, when there were present at the hearing 115 Lord Radcliffe, Lord Morris of Borth-y-Gest, Lord Pearce, Lord Upjohn and Lord Donovan—no mean assessors of evidence. This is what they said in relation to the question of pure water supply: Their Lordships are of opinion that an Act empowering local authorities to supply pure water should receive a fair, large and liberal construction as provided by Section 5, paragraph (j) of the Acts Interpretation Act 1924. They are of opinion that as a matter of common sense there is but little difference for the relative purpose between the adjectives 'pure' and 'wholesome'. The water of Lower Hutt is no doubt pure in its natural state but it is very deficient in one of the natural constituents normally to be found in water in most parts of the world. The addition of fluoride adds no impurity and the water remains not only water but pure water and it becomes a greatly improved and still natural water containing no foreign element. Their Lordships think it right to add that had the natural water of Lower Hutt been found to be impure it would of course have been the duty of the respondent corporation to add such substances are were necessary to remove or neutralise those impurities. But that water having been made pure they can see no reason why fluoride should not be added to water so purified in order to improve the dental health of the inhabitants. My Lords, I do not propose to discuss the general issue of the relationship between individual rights as against the State's rights. This problem has been discussed by theologians, by philosophers and by politicians from the days of ancient Greece. But I would point out that no recognised civil rights or liberties are absolute and unqualified. We all believe in freedom of speech, but that freedom is limited by laws which impose penalties for sedition, blasphemy and obscenity and for criminal libel. The noble Lord said that he doubted the legality of fluoridation. He has had an opportunity of testing it. An action was to have been heard. I believe at Watford, but was withdrawn. But in fact the legality of fluoridation has been tested. I have read two judgments, but there are others. In the United States every single court of last resort which has had occasion to review the question has ruled, after a full hearing of its merits, that fluoridation is legal and a proper exercise of governmental power, and does not constitute an enfringement of individual constitutional rights. And this ruling has been affirmed on many occasions by the Supreme Court of the United States.

116 My Lords, it has been said that this is "the thin end of the wedge". It is the kind of argument which is so often advanced when all other objections have failed, against innovations to improve the public health. It came with the reinforcement of bread. But are we not entitled to assume that if any other measure is proposed it will receive the same careful degree of scrutiny and control as has been given in this case by the Ministry of Health? They suggested the introduction of fluoridation after eleven years of the most careful study, through free discussion of its value. The noble Lord must not confuse freedom of action for freedom of belief. After all, if fluoridation is introduced into any area (I am glad to say that more than 90 local authorities have adopted fluoridation as against 50 who have rejected it) and if it is introduced with the consent of the elected representatives of the people, there will still be no restriction on the noble Lord and his colleagues from ventilating their views against fluoridation and trying to persuade the appropriate authority to alter its decision.

§ VISCOUNT STUART OF FINDHORN

My Lords, would the noble Lord not agree that it depends on the local water supply? In the north of Scotland, where you get more peat, you want more medication, and if you go to Dorset, say, where you get a lot of chalk, you probably will not want any at all.

§ LORD COHEN OF BIRKENHEAD

I am sure, my Lords—I am sorry; I put a sweet in my mouth in order to moisten it—

§ LORD BOWLES

Fluoride?

§ LORD COHEN OF BIRKENHEAD

I should be quite prepared to drink half a tumbler of fluoridated water.

Certainly this has to be decided by the local conditions, and that is why I say it is decided by the elected representatives of the people. But I hope that if the National Pure Water Association and its supporters continue to object to fluoridation, as I have no doubt that they will, they will pay greater regard to the ethics of public controversy and refrain from reckless, inaccurate and misleading statements. They have declared on several occasions that fluoride is a poison. My Lords, "Fluoride is a poison", "Fluoride 117 is not a poison", are, in fact, statements which are neither true nor false, because it depends upon the dose whether fluoride is or is not poisonous, just as it depends on the dose whether aspirin is curative or poisonous. In bitter almonds, my Lords, though you may not have suspected this, and in the almond icing which you all so much enjoy, there is prussic acid, but not in amounts likely to cause toxic effects. Those of you who have been nearly drowned know the toxic effect of common salt in seawater. It is true that sodium fluoride and sodium fluoro silicate, which are added to water for the purpose of fluoridation, are included in the British Poisons List Order of 1962, Part II, Schedule 2. So is hydrochloric acid, and I trust that all of us who are healthy have not less that .02 to .04 per cent. of hydrochloric acid in our stomach juices.

§ VISCOUNT STUART OF FINDHORN

No, I have to take some.

§ LORD COHEN OF BIRKENHEAD

I do not object, even though it be a scheduled poison.

§ VISCOUNT STUART OF FINDHORN

My nature is so sweet that I have not all the acid I need.

§ LORD COHEN OF BIRKENHEAD

I suppose that that has only been in the last few years. To say that fluoride is a poison is a meaningless phrase, which is designed to produce an emotive response. To put through the letterboxes in and around London a card saying that it is proposed to put a poisonous substance in the water supply, so worded and designed that the Metropolitan Water Board had to make an announcement saying that it was not from them, seems to me to go beyond the normal ethics of public controversy.

The noble Lord, Lord Douglas of Barloch, said that Manchester had refused fluoridation. In fact, it did. The Chairman of the City's health committee, Alderman W. O'Nions, in defending this recommendation, said that President Kennedy—this was in August, 1963—did not drink water with fluoride in it although fluoride was contained in the Washington water supply; the President and Members of the Senate had a supply from private sources. That was absolutely untrue. When that appeared I 118 wrote to my friend the Surgeon-General of the United States and asked him whether any change had been made in the President's drinking habits, and he said, "No." He wrote that the President had made a statement only two or three months before saying: I urge parents, dentists and health organisations to renew their efforts to improve the dental health of the nation's children by stressing the value of dental education and advocating such preventive measures as the fluoridation of public water supplies. Such contributions will mean stronger, healthier children and eventually a healthier America. And Dr. Janet Travell, the personal physician of the President, said that the President and his family drank the water provided by the District of Columbia. That your Lordships may think is a curious type of controversy.

A month or so ago in The Times there appeared a letter stating that the Pasteur Institute was against the fluoridation of water supplies. I wrote immediately to the writer of the letter saying that this was untrue and would she please acknowledge that it was untrue. She sent me a personal letter saying that she had made a mistake, but there was never a public withdrawal. Again, it was said that in this Ministry pamphlet, which has been referred to so much, the Minister had said that we should not boil water because it might so concentrate fluoride that it would have poisonous effects, and we should not drink water in which vegetables had been boiled if the water supply had been fluoridated. That is a complete fabrication, which was denied by the public relations officer of the Ministry.

Then there is the worst form of criticism, which implies ulterior motives—that the fluoridation programme has been established in order that the waste product of a particular industry might find some use. It has been alleged (I have a letter here, though I will not read it, from a Mr. Bridges) that the price of fluoride has increased tenfold since fluoridation was introduced. That, too is untrue. The price has increased by 5 per cent., due to increased labour charges.

But of these statements, perhaps the most outrageous is one which is on one side of a leaflet on which is a reprint of a letter from the noble Lord, Lord Douglas of Barloch, to the Daily Telegraph. I do not hold the noble Lord 119 responsible for that, but on the other side of the leaflet it says: Red scheme for mass control".

§ LORD DOUGLAS OF BARLOCH

My Lords, will the noble Lord allow me to interrupt? I did not authorise its publication, and when it came to my notice I wrote to the people who had put it out and objected to it most vigorously.

§ LORD COHEN OF BIRKENHEAD

My Lords, I did say that I did not think that the noble Lord had allowed his letter to be published on the back of this document. However, it says that Fluoridation is a very definite method of ultimately reducing the individual's power to resist domination by slowly poisoning and narcotising an area of brain tissue which will make him submissive to those who wish to govern him". I can only say that this is not a Party political issue, and that no Party can expect to derive any particular form of benefit from this form of medication. Indeed, it was during the former Administration's period of office that fluoridation was advised, and it was as keenly supported by the present Minister when he was in Opposition, as he does now as Minister. This is no nefarious or subtle plot. It is a measure designed to improve the health of the people which, as Disraeli observed, is the chief foundation of our power and happiness as a State, and it is supported by bodies whose integrity and authority are overwhelming.

It is perhaps a revealing comment on some of the criticism of fluoridation that a Mrs. Sykes, in the Rotherham Advertiser of November 2, 1953, wrote: Fluoridation is not a public health measure but a stunt for extending the power of public officials. In nearl, half a century of the study and practice of medicine, I have witnessed the same opposition, usually from the same quarters, to innovations designed to improve the health of the people. The pasteurisation of milk was opposed. The incidence of surgical tuberculosis is now 7½ per cent. of the incidence 25 years ago. Diphtheria immunisation was opposed less than a quarter of a century ago. It was introduced in 1942. In the decade before 1942 there was an average annual incidence of 55,000 cases of diphtheria, involving 2,783 deaths. Until a death early this year, for two years there have 120 been no deaths from diphtheria in this country and but a handful of cases. In 1957, when I chaired the committee which advised reintroduction of polio vaccination, against great public opposition from certain quarters, there were 5,000 cases of polio, with 200 deaths and many hundreds of gravely crippled patients. In 1965, there were two deaths. I cannot give the exact figure of cases at the moment because it has not yet been finally ascertained, but there were certainly not more than twenty or thirty.

In all these cases, the objections were overcome and hundreds of lives have been saved and made happier, fuller and more productive, because of these beneficial measures. I am confident that intelligent people will not allow the most authoritative and informed professional advice to be nullified by unfounded assertions and emotional pleas.

§ LORD TAYLOR

My Lords, my noble friend Lord Cohen of Birkenhead has almost completely disposed of my noble friend Lord Douglas of Barloch. He has not quite done so—he was too kind. My noble friend Lord Douglas of Barloch, whom we all admire and like very much, did not hesitate to impute motives to the officers and advisers of the Ministry of Health and to many medical scientists throughout the world.

§ LORD DOUGLAS OF BARLOCH

With respect, I did not impute any motives to anybody.

§ LORD TAYLOR

Let us see what my noble friend did say. I made notes of some of the things he said. He said that fluoridation was a form of or parallel to an international war cry. He said that it was supported by dubious statistics, suggesting, presumably, that they are "cooked". They are not "cooked". Indeed, if there is any evidence of "cooking", I think it is the other way. "Concealment of relevant facts" was another phrase that he used. There has been no concealment of relevant facts, save by the advocates of anti-fluoridation. "Completely unscientific; inaccurate and misleading statements", were other phrases he used. But the most awful statement he made was that fluoridation "might cause congenital deformity". That is a most irresponsible thing to say.

121 Then he said it "might cause mongolism". My noble friend Lord Cohen of Birkenhead has dealt with the case advanced that fluoridation causes mongolism; and it is, of course, nonsense. Equally, to suggest that fluoridation causes congenital deformity is rubbish. We were told that "up to 10 per cent. will suffer from chronic fluoride poisoning". This is all nonsense.

The tragic thing about it is that my noble friend does not confine his nonsense to us here in your Lordships' House, who have the benefit of my noble friend Lord Cohen of Birkenhead to put us right. This sort of thing is sent out to all local councillors whenever the subject is raised. They receive a pamphlet from the so-called National Pure Water Association, which again, as my noble friend Lord Cohen of Birkenhead has shown, is a fabric of misrepresentations arid, I would say, falsehoods. It is hard on the councillors. I feel that this is a most unfair and very had form of propaganda. And it is hard on the children who get the dental caries.

What does my noble friend suppose that we who advocate fluoridation think about it? I do not particularly advocate fluoridation: I take the evidence such as it is; and, on that evidence, it is common sense that this is the right thing to do. This is not a sort of great plot to enforce fluoridation on people. It is highly desirable, if dental caries can be prevented, that it should be prevented. But we have to counter all this propaganda. Every time the matter comes up before the unfortunate councillors, who are by no means necessarily so skilled in assessing highly technical evidence, and certainly have not the benefit of the speech of my noble friend Lord Cohen of Birkenhead, it makes it very hard indeed for them. There is a very good letter in the Lancet this week from a medical councillor describing what happens. I will not read it, but it is a clear statement of the way in which the National Pure Water Association gets at the councillors and confuses them, with the result that the children's teeth suffer. I do not propose to say anything more. I think my noble friend Lord Cohen of Birkenhead has completed the job, and the less we hear in the future on the subject of anti-fluoridation, the better.

§ LORD AMULREE

My Lords, when I first saw this Motion on the Order Paper in the name of the noble Lord, Lord Douglas of Barloch, I thought that we might be able to have an interesting and constructive debate, going round the subject and approaching it from various points of view. I am bound to say that I was rather shocked at the way in which he put forward his case. I do not say that I associate myself entirely with what the noble Lords, Lord Cohen of Birkenhead and Lord Taylor, have said, but I cannot agree with the way in which the noble Lord, Lord Douglas of Barloch, put his case.

I have risen to my feet to make two short points, and in respect of one I must declare some interest, because in 1955–56 the Ministry of Health in England decided to carry out a controlled experiment in six areas. They were going to take three areas where the water did not contain a great deal of fluorine, and the results were to be contrasted with areas where the fluorine content of the water was to be put up. One of the areas chosen was supplied by water from a company of which I have the honour to be one of the directors, and naturally I was interested. Hard water which comes from chalk, from an uncontaminated source, has to be treated by Act of Parliament to make it soft, and before it goes into distribution we give it a certain amount of chlorine as a final disinfectant. But the content of fluorine is very low, about 0.1 parts per million, which is almost as good as saying none at all. The results on children up to six or seven were to be contrasted with those in a corresponding town where the fluorine content had been pumped up to about 0.9 parts per million.

The other four areas involved happen to be in Wales, and there, when the result came out, it showed what one expected from the large amount of statistical evidence, which I agree had come mainly from America: that in the areas where fluorine content was high the amount of dental caries was considerably lower than it was in the areas where the fluorine content was low. The rather curious thing about it was that it was not entirely parallel with the results that came from the area in which I am interested and the one which was 123 chosen against it. There the effects were far more equivocal. One did not get a really clear picture about whether children do not get less dental caries or about the proportion who are free from dental caries. What we did find was that the number of children who had ten or more teeth affected by dental caries fell considerably in the part of the world where the fluorine content was increased. So that, although it was not completely conclusive, the tendency was the same, though not so well marked. This was a good-class residential area (I think my noble friend Lord Cohen of Birkenhead referred to this) where parents take good care of their children—probably considerably better care than in some of the more country parts. It seems that other factors come in as well as the fluorine content of the water

The second point I wish to raise comes from some kind of sympathy with the people whom the noble Lord, Lord Douglas of Barloch, represents. Supposing there happens to be a certain proportion of the population who object—whether conscientiously, or not, I do not know—to their water being treated in some way to improve their health. That again is a very curious thing. These people who object to things being put in the water to improve their health do not object to drugs and chemicals being added to make the water potable. They are happy that water should be treated to make it wholesome, but they are not prepared to accept water being treated if it is done as a preventive measure

Another way occurred to me in which fluoride could be given, I would not say universally, but in order that mothers could use it for their children. I would refer to what has occurred with regard to some Alpine waters which you meet with in the middle of Europe. Recently there was a large amount of vaud-goitre due to the fact that there was not sufficient iodine in the waters coming from the mountains. There was a big educational compaign in that part of the world to make people take salt which was treated with iodine—iodised salt. That campaign was fairly successful, and I should like to quote to your Lordships one or two figures. In one of the Cantons of Switzerland, the incidence of goitre among the adult population was 77 per cent. in 1924, and it fell to 21 per cent. 124 in 1937 after the campaign for iodised salt. In two other Cantons, where young recruits going into the Army were examined, the incidence of goitre fell in one Canton from 7 per cent. to 0.1 per cent., and in the other from 4 per cent. to 0.5 per cent. In the town of Lausanne, where schoolchildren were tested, the amount of goitre fell from 57 per cent. in 1924, to 1 per cent. in 1937.

I do not pretend to be a chemist, and I do not pretend to know much about the pharmaceutical industry, but I am told by those who do that it would be possible to prepare a form of fluorised salt as one prepares iodised salt. I wonder whether it might be a way round the difficulty, if the numbers of people who object to fluoride in their drinking water is very large, if some kind of educational campaign were carried out among mothers; because, after all, the important time to get the fluorine is between the ages of 2 and 7, or 2 and 10. If that could be done, I wonder whether we should get a certain result coming from it? I agree that we should not get as big a result, because there would be some people who would not take advantage of this. But I wonder whether it would not be worth while thinking about that—not because I sympathise with the people who object to it, although I can see that they have a point of view, but if one wants to carry out a big reform one wants to carry it with willing support rather than against hostility

I think those are the only two points I want to make. I should like to repeat what has already been said; that is, that there is no evidence at all that giving fluoride up to 1 part per million can cause any danger to health at all. Such danger has never been shown and I think it is not true when people say that a poison is being put in their water. I admit that if an enormous amount of fluoride were added to water it would be a poison, in the same way as an enormous amount of chlorine in the water would be poisonous. If you put an enormous amount of lime in the water to soften it, that would be a poison. Any thing can be made a poison. but we are talking about bringing it in in a perfectly safe therapeutic dose, and I can see no reason to say that any harm can occur 125 by water being treated with the amount of fluorine which is proposed.

§ BARONESS SUMMERSKILL

My Lords, although I fully understand how strongly my noble friend feels and, indeed, realise how strongly he expressed himself just now on the statements made by my noble friend Lord Douglas of Barloch—statements so sweeping in character, so dogmatic, and, indeed, statements which outside this House could be slanderous—nevertheless. I confess that I listened to my noble friend Lord Douglas of Barloch more in sorrow than in anger. We have listened to him time after time condemning colouring substances and preservatives which are used in food, which have not been adequately tested, and many of us have supported him. We have listened to him on the case of Rachel Carson's book on pesticides, and we have recognised that many of these fertilisers and pesticides are lethal. Again, very often we have supported him. But I find it difficult to understand why, having studied these matters so carefully, he has not realised that there are exceptions to all these rules. Surely he does not, for instance, suggest that D.D.T., which is used to eradicate malaria, is lethal—or does he?

Then again, having read my noble friend's Motion, it looks to me as though he condemns all preventive medicine, because in his Motion he is dealing not only with fluoride but with all mass medication. The whole field of immunisation can be regarded as preventive medicine. According to the Motion before the House to-day, the noble Lord does not simply condemn fluorides; he condemns preventive medicine as practised in the field of immunisation.

§ LORD DOUGLAS OF BARLOCH

No.

§ BARONESS SUMMERSKILL

I am glad that he withdraws mass medication, because if he reads his Motion he will see that any doctor would interpret it in that way.

I would ask him whether he thinks that nature is infallible; that man-made drugs and substances can make no contribution to improving upon nature. When I mentioned D.D.T. I recalled that in the Press this week it was said that in Jamaica and Trinidad malaria has been eradicated 126 with D.D.T. and the anti-malarial drugs. I think that man is evolving and proving himself capable of outwitting nature. The case before us to-day leads us to believe that this is so, and if we believe it then we must inevitably accept the expert opinion.

I am the fourth doctor who has spoken in this debate, and none of us pretends to be an expert on fluoridation. But why do we support it? We support it because we are capable of assessing the value of the expert opinion which has been expressed, precisely in the same way as the judges who have been mentioned. The noble Viscount, Lord Stuart of Findhorn, asked my noble friend Lord Cohen of Birkenhead whether the judge he quoted was an expert in the matter. No, but judges are put where they are because they have a training and possess a wisdom and a common sense which makes it possible for them to assess evidence which comes before them. The reason why the four doctors in this debate are unanimous on this issue is that we are able to assess the evidence. We know the kind of people who are at the Ministry of Health: and, after all, they have been talking about this matter and discussing it for the last eleven years. We know they are men of integrity, and we know they have no interests in making money in fluoride.

The latest pamphlet which has been sent to us only this afternoon—one to my noble friend and one to me—has on the front a picture of a man with a dollar sign on his hat, and it suggests that he is making money out of fluoride. I presume the corollary of that is that we here are supporting fluoridation because perhaps my noble friend and I are making 5 per cent. on the side. This kind of suggestion is absolutely fantastic. It underestimates our intelligence, besides insulting it; and I would ask my noble friend, in his own interests, to stop this really scurrilous form of propaganda. It does not help; it only condenms him and his friends.

My noble friend Lord Cohen of Birkenhead has mentioned pasteurisation. I was going to make that point, and if there are noble Lords here who are still unsure whether the experts should, on the whole, be supported or rejected, I would remind them that for fifty years in this country experts, doctors and all kinds of people warned the country that milk could be 127 dangerous; that it could cause gastrointestinal complaints; that thick, creamy milk, looking delicious, straight from the cow, particularly from the West Country, could be alive with tubercle bacilli and could cause bovine tuberculosis, with the result that little children got meningitis, the glands in the neck were affected, there were joint infections, and such children spent their lives in some orthopædic hospital.

The debates went on, here and in another place, for years, and I am sure that many noble Lords present who were in another place will remember that the noble Viscount, Lord Dunrossil, who was formerly the Speaker of another place and before that Minister of Agriculture, sought to introduce a Bill which embodied in it a proposal to pasteurise all the milk of the country. That was in 1938. Within a few days of the production of that Bill the Minister of Agriculture had to resign, and the President of the National Farmers' Union took his place. The kind of prejudice that we have heard to-day, the antagonism to reform in this field, was so great that it was very difficult to clean the milk supply of the country.

I had the great satisfaction of introducing the Clean Milk Bill in 1947. What has been the result? From 1947 to 1966 the great orthopædic hospitals which housed these pitiful children lying in plaster have had beds to spare, and we are wondering what to do with them. The change has been so dramatic that it is difficult even for doctors to believe that such a thing could happen. For years we heard speeches of the kind that we have heard this afternoon, condemning those who wanted to clean the milk as cranks; as ignorant. We were told, precisely as we have been told this afternoon, that if we tampered with the milk of the country the ailments from which the people of the country would suffer would be numberless. They sat in another place and listened, as no doubt they did in your Lordships' House, with the result that decades passed before the House could get that legislation through. But now it has been proved beyond doubt that the Ministry of Health in those days was absolutely right. All those reports we had coming from the Ministry of Health, all the deputations, all the investigations, 128 have been proved to be valid, and I ask you this afternoon, my Lords, again to recognise that history is repeating itself: The experts are saying to you that, after careful investigations of all kinds, they believe that this is the right policy.

I would remind you, too, that the United States of America have been doing this for eleven years. Are they behind us, so far as the organisation of their food and drugs bodies is concerned? Not at all. Let me remind your Lordships that when the thalidomide scandal came to Europe, America was saved. No deformed baby was born in America as a result of the use of this drug, because their food and drugs organisation was so strong that it refused to allow thalidomide to be distributed. Would these same people have allowed fluoride to be added to their water without an outcry? As those of your Lordships who have visited America will know, they are all very health-conscious, and they have had fluoride added to their water for eleven years. All we are asking now is that we should do precisely the same in this country.

I would say one thing to my noble friend, Lord Douglas of Barloch. He was warning the House about what would happen if fluoride was added, as though it were something fresh to be added to water. But I would ask: does he realise that he has consumed fluoride to-day? It is in our normal diet. On the many occasions that we have chatted together at teatime, he has been drinking fluoride, because tea contains, in proportion to its weight, more fluoride than any other commodity. I know that he has refused to have milk in his tea, because he has said to me that it was probably pasteurised; but apparently he has not realised that he has taken fluoride in his tea. I say this to prove that one cannot make these dogmatic statements, dismissing the people who have devoted the whole of their lives to the subject, and say, "Well, after reading a few pamphlets I am an expert."

Therefore, my Lords, I ask you to-day to be guided by the men and women in this country, in Europe and in the United States of America who have knoweldge of this subject, and particularly by that powerful speech given by my noble friend Lord Cohen of Birkenhead, and to support the fluoridation of water supplies.

§ LORD COHEN OF BIRKENHEAD

My Lords, may I make one point? I think the noble Baroness said that in the United States of America fluoride has been added to the water for eleven years. It is in fact twenty-one years since it was first instituted.

§ BARONESS SUMMERSKILL

I am sorry if I was in error. But it is better to make an under-statement than an overstatement.

§ LORD COHEN OF BIRKENHEAD

My Lords, I quite agree, and I hope that the noble Baroness will remember that in future.

§ EARL WALDEGRAVE

My Lords, I feel rather a David among many Goliaths in intervening in this debate. We have heard to-day some eminent doctors. I, for one, am not likely to wish to disagree lightly with the noble Lord, Lord Cohen of Birkenhead, to whom I do not say dramatically that I owe my life, but I certainly owe my health to him. Therefore I do rot want to disagree with anybody. I want to try to lower a little the passions that have been raised in this debate. I must first of all perhaps declare an interest—it is fashionable to do that in your Lordships' House nowadays. My interest is that for some thirty years I have been connected with the water industry in one way or another and for many years I have been a director of one of the biggest statutory water companies. Also for many years I have served on the water supplies committee of a county council, and I have always been tremendously interested in this subject. However, I am not speaking on a waterworks brief today, and anything I say is purely a personal view and a personal request for information.

I think it is fair to say, if I give my personal view of what I think the opinion of the water industry is, that we are benevolently neutral to this fluoridation of the public supplies of water. We think we can do the job if we are asked to do it. If the public want it and the public health authorities say we should and it is required by the Government, we think we have the technical skills. I would say at once that there is no particular reason why we should want to do it; there is no money in it for the water 130 companies, and there would be difficulties in doing it. It would be easy for the big companies with a big central source, but it would be more difficult for small companies with a large number of individual sources. Birmingham which has, I understand, already agreed to fluoridation, has perhaps rather an easier job than some to deal with it. The cost, I understand, will not be very great.

A point that some people feel ought to be considered is that the amount of water which is actually drunk, and not used for industrial purposes or simply going down the drain, is a very small proportion of the gallonage. I do not know what the proportion is in my own company. We supply something like 55 million gallons a day. I do not know what proportion is drunk or what proportion of that drinking portion is drunk by children or pregnant women; it must be very small indeed. And yet we have to fluoride all the water. But let that pass.

I want to speak for a moment on another point. In passing, I must say that I feel that there is a little more in the principle of objection to mass medication. I know it has been argued that this is not mass medication; that fluoride is an additive. But, be that as it may, there is a constant temptation by the experts and the scientists and our rulers to know best and to be—shall we say?—at best paternalistic and at worst resolved to try to compel us to be good. I am not at all sure that is always desirable, and it is not always—in fact, it is very seldom—possible. We must beware of this desire to do good in this way unless we are very very sure of ourselves.

We could, for instance, most sincerely go a long way on this particular subject. Most of us, I think, know that alcoholism is a very great evil and causes dreadful damage and loss and expense to the community. No doubt it would be possible to put into the public water supply some harmless chemical that would not produce mongol babies but would make people sick when they had a glass of beer. I do not believe you would be justified in doing it. The same thing, of course, could be done with cigarette smoking: something could be added to the food which would make people not wish to smoke cigarettes. I do not believe you should do it. Where would you stop? 131 You could add some form of tranquilliser to make people more patient on the motor ways and not overtake and not be bad tempered. It would save a lot of money and save much time in the law courts. But it is not quite what we ought to do.

This, perhaps, is the justification for the noble Lord, Lord Douglas of Bar-loch, using in his Motion the words that we must "draw attention to the question of mass medication". This is not in any way, surely, in the words written here, opposing diphtheria immunisation or the pasteurisation of milk, which the noble Baroness, Lady Summerskill, was talking about. I should hate to be associated with any such propaganda. I myself, long before I had a seat in your Lordships' House, was a member of a public health committee of a county council, and proud to work with the medical officer of health there, Dr. Savage, who was, I think, one of the first in this country—it was in the early 'thirties—to introduce diphtheria immunisation. And how hard we had to work to get it introduced! But there is a difference here from that kind of thing. It is extremely difficult for the layman to argue against the expert, and the only question I want to raise this afternoon is: are we quite sure that here, in this fluoridation of public water supplies, there is an acceptable risk, or, indeed, that there is no risk at all? Because I doubt whether we ought to embark on this unavoidable medication, or compulsory additive to the water supplies, even if the great majority of expert opinion is at this moment satisfied that it is making an improvement to our teeth, as long as there is any reasonable shadow of doubt. It is because of the very nature of the case that it is unavoidable.

There has long been conscientious objection to vaccination—or there was; I do not know whether it still exists—and many of us, as magistrates, had tussles with our consciences when we had to sign certificates for lazy or superstitious people, saying that they conscientiously objected to vaccination. But we had to do it. If you go to a lot of trouble you can find and buy whole-meal bread, if you feel you ought to eat it. If you go to a lot of trouble you can buy unpasteurised milk, if you think you prefer to take these risks.

§ LORD TAYLOR

Can one buy unpasteurised milk?

§ EARL WALDEGRAVE

I do not know whether you can buy it but you can certainly drink it, because I do in my own household—not because I object to pasteurised milk, but I happen to be a cheesemaker, and all our own milk is used in our dairy and it is not pasteurised.

§ BARONESS SUMMERSKILL

But the milk the noble Earl is talking about comes from an attested herd?

§ EARL WALDEGRAVE

Certainly; I have always been in favour of that.

§ BARONESS SUMMERSKILL

The milk I was talking about was the milk which came from cows which were unattested in the old days.

§ EARL WALDEGRAVE

One of my own daughters and one of my domestic servants suffered from bovine surgical tuberculosis of a most disagreeable character from drinking milk from tubercular cows, which I bought in good faith as tuberculin-tested cows. That was many years ago. But the point I was making was that the difference here, in the mass additive to a public water supply, was that, for better or for worse, there was no practical alternative for most people if they conscientiously objected to the addition. Except for a very few people living in the country who might have their own well, it would not be possible. Therefore, all I say on that point is that we must be quite clear that there are no risks, and we must not chance our arm at all.

This is where it becomes difficult for a layman to speak, having heard the noble Lord, Lord Cohen of Birkenhead, in his most powerful speech. I hope he will not think, and the noble and learned Lord who sits on the Woolsack will not think, I make a joke in bad taste if I say that I remember a book that was written about the ghost at Borley Rectory. I happen to know quite a lot about it because my family, or my ancestors, were involved in it. An edition of that book had a preface, I believe by a learned Judge, or at least a learned King's Counsel, who said that the evidence of whoever had written the book was so good that he had hanged a man on—it or words to that effect. 133 We know how unfortunate that remark was, because before the man who wrote that book died, he admitted that he had fabricated it all. So even the most skilled people in weighing evidence can make mistakes; we are human.

I do not want to labour that point. The experts have made mistakes in the past. I should have thought that, taking away all the prejudice, taking away all the pure propaganda—because there is a great deal of pure propaganda in much of the literature from the Pure Water Association (or whatever it is called; and I am not a member of that Association)—there still remains an element of sincere and knowledgeable doubt. The noble Lord opposite shakes his head, but I, as an absolute layman, as a member of the public with no scientific knowledge at all, am entitled to say that the impression I get is that there is a slight element of doubt.

§ LORD TAYLOR

Sincere, but not knowledgeable.

§ EARL WALDEGRAVE

The noble Lord says "Sincere, but not knowledgeable". We have had a certain amount of logic chopping and interruption this afternoon. I did not want to engage in this, but I think I shall have to.

The noble Lord, Lord Newton, interrupted the noble Lord, Lord Douglas of Barloch, when there was a discussion on Mongolism, a subject on which I do not know anything. The evidence the public have is contained in two documents. I asked the noble Lord what evidence he was quoting on another subject, and he said it was not a published document that was available to the public. But these two documents are available to members of the public. One of them is a public health leaflet, No. 105, and there is a Ministry of Health leaflet on fluoridation. It is so short that I must quote it. I thought that my noble friend Lord Newton was a little unfair, to the noble Lord, Lord Douglas of Barloch, on this point.

On page 43 of the Ministry of Health document there is a short paragraph on Mongolism which says this: Rapaport (1956 and 1959) reported that in towns and cities in four American States there was a positive relationship between the proportion of Mongol births and the fluoride content of the water supply. Berry (1958), who investigated the incidence of 134 Mongol births in South Shields, West Hartlepool, the high fluoride part of Slough and suitably matched low-fluoride areas, obtained no confirmation of Rapaport's findings. One man says it was, and the other man says it was not. The Ministry of Health pamphlet says that a careful investigation has shown that there is no basis whatever for any suggestion that there is a connection between fluoride in the water and the number of births of Mongol children. These are the only two pamphlets that I, or ordinary members of the public, have on this subject. Noble Lords can draw their own conclusions as to whether we think that is a fully argued case. I would have suggested, from what I have heard and seen and read about this matter, that if one were a Scottish lawyer one might be glad temporarily to be able to say "Not proven". I am not sure. I wonder. I hope that the Minister will be able to help a good deal when he comes to reply.

At the great age that I have now attained, and with such a vast number of grandchildren, one is always accused of being hopelessly reactionary and conservative. Also, one's mind does not work so fast as it did; one cannot pick up all these new ideas, and it is getting more and more difficult to keep pace with the experts. Of course we must take risks. But are we, perhaps, on occasion nowadays, being just a little too precipitate? Do we sometimes go too fast, and is it wrong to say that? The technologists get urged on by the economists—an unholy combination of people, neither of whom one can ever understand. They are saying that it pays, and also that it is scientific. There we are.

Then we had thalidomide. There were some rather red faces about agene in bread. The scientist tells us: "You really must take it from me that it is all right. I am a scientist; I know." Then of course somebody found that a dog went mad when it ate biscuits which contained agene. It was thought that a man might go mad, and had we not better withdraw it? So it was withdrawn. It is extremely difficult for us, as laymen, not to remember these cases which happen from time to time. How can we as laymen know whether it was wise of all these factories to connect themselves so 135 precipitately to this new-fangled gas produced by this new-fangled process in the West Midlands region before they knew whether or not the machinery would work? Now, apparently, everybody who is responsible for making these machines says, "Oh, but you must have realised that these were new and untried, and of course we must have our teething troubles. Goodness, what do you expect?". What do we expect?

Of course we want, for instance, to have long link rails on the Western Region of the railways, on which I travel, and on which I hope to travel this evening, if I do not speak for too long. We were told when we were children that if very long links of rail were put down they would expand in hot weather and contract in cold, and so we had to have short links, because otherwise the trains would run off the rails. It is said, "This is nonsense. You are not up to date in your science". And now they have put long links down by Didcot and the trains run off at the rate of about 19 a month—or so it seems to those of us who travel on this railway. Then the diesel locomotives came in, and it was said, "You do not want to go about with coal-fired locomotives any more, do you? You might as well go back to the horse and carriage and have done with it, if that is your view." All right; but do not let these experts force these things upon us before they are ready to be used. Half the time now the diesel engines are broken down, and the steam arrangement which is supposed to heat the carriages in cold weather does not do so.

Travellers in aeroplanes are proverbially anxious to get as quickly as they can from point A to point B. They also strongly object to being taken in nosedives towards the airports. They like to be taken down gently. But are we quite wise to work out a flight plan which takes you only two thousand feet above the summit of Mont Blanc in a snowstorm in mid-winter, as a result of which over 100 people die? Their relatives probably think that is not quite wise. So there is always this: that you can go too fast. You have to stand up against the experts, and if you are going to carry on sensibly you have simply got to make them prove these things without any shadow of doubt to a lay mind, before 136 you accept some new-fangled arrangements.

I come to the two points that I want to raise. I hope I shall not be considered critical of the engineers or technicians in the industry to which I am proud to belong, the water industry, if I ask one or two questions which I hope that the Minister may be able to answer when he comes to reply. One part per million of the substance, that is to say the free fluoride ion, is the optimum dose we should have in water. I think that it is added to the water as rather more like two or three parts per million of sodium silico fluoride. This stuff obviously dissolves, but to my mind one part per million is long odds, when two, three, four, five or six parts per million is considered too much. I suppose we are now absolutely certain that this stuff is going to permeate or diffuse (or whatever is the correct scientific term) equally throughout the million gallons of water. Is it going to come to the top, or go to the bottom, or stick to the pipes at the side? Will it have any chemical reaction, with some other chemical or some other impurity which may be in the water? I certainly do not know the answer to these questions. We certainly have not been told about these things because the process is still in its comparatively early days. Do we really know about this, or have we, as is so often said in these pamphlets, no evidence to the contrary?

§ LORD COHEN OF BIRKENHEAD

My Lords, may I interrupt for one moment? This is quite untrue. The Government Assistant Chemist, Dr. Longwell, published a paper in 1957 which showed, from the taking of samples at regular intervals from fluoridated water supplies, no significant difference in consecutive samples taken over a long interval of time. So that there is no doubt that fluoridation cannot give rise to such excess that it would give rise to toxic symptoms.

§ EARL WALDEGRAVE

I thank the noble Lord very much, but that does not quite answer the point I am making. If I may develop the point, from my slight contacts with scientists I thought that what they were pretty clear about was their lack of knowledge concerning what I believe is called Brownian motion, as to how substances disperse or diffuse. Do 137 we know exactly how this chemical is going to diffuse through the supply? I know of cases in which there are doubts. It would be interesting if the Minister when he comes to reply would let us know whether, for instance, in Birmingham or in any of the other big cities with fluoridated supplies they have had, or are having, any difficulty in getting this chemical to dissolve satisfactorily in bulk. I am not trying to spread alarm and despondency, but I think that perhaps alarm and despondency have been raised by excessive propaganda.

Mine are intended to be sober questions which can be simply answered, if the answers are known. Perhaps the Minister can assure us that there is thoroughly satisfactory testing apparatus available which will test and record the amounts of fluoride actually present in the supply. This may be perfectly possible to do in an analyst's laboratory, but I think that the public want to be assured that the ordinary hobnail-booted assistant at a waterworks has a machine which can do this accurately in the field, as we say. Most of us have had experience of some chlorination plants which go wrong. If one puts too much chlorine in the water one knows it at once, and the complaints come flooding in. Nobody can make tea because it smells horribly. I am told that fluoride is tasteless and is not easily detected. It may be easy to do these things in practice, but I want to be assured that in fact it is.

I have heard it said that some of the apparatus is in its early days. I received a letter written in 1964 in regard to an area where there was a fluoridation of supply, which said that there had been considerable difficulty in getting the substance to dissolve satisfactorily. Apparently, the chemical in suspension was passing onward from the solution tank, the design of which had already had to receive one alteration. Therefore, we want assurance on these points. I have doubts about the mechanics of it. It has been said that one part per million is not dangerous, which I accept. It has been said that that amount is good for us, which I also accept. But we want to be absolutely sure that we are not, because of some human error, going to get 40 parts per million, which might be bad for us. We need to be assured of this, 138 by quite positive proof, before we impose this process on people who conscientiously object to it.

There is another area in which I am interested personally, and upon which I shall touch briefly. My wife is at this moment in correspondence with the Minister of Health about this matter. He is being most helpful, courteous and thorough in his inquiries and in the correspondence which is ensuing, and therefore I hesitate to bring up the matter at all. But I happen to have had a grandchild who was born in Kenya where there is an excessive amount of fluoride in many of the boreholes. My grandchild's deciduous teeth were practically non-existent, and all had to be removed. The next batch of teeth are now erupting, there is considerable difficulty and it is turning into a long medical case.

The dentists in Nairobi had no doubt that this was clue to there being too much fluoride in the water. They said, "We get this a good deal in borehole water. It affects Europeans rather more, as they are not used to it. We are always running across it. Bad luck!" It is a little worrying when the Minister's reply, so far, is in these terms: I am advised that it is doubtful whether the dentist in Nairobi was fully justified in his conclusion that the dental condition was due to fluoride. He may be right, but we are going on with this inquiry. The point is that he is not quite sure; there is an area of doubt. He then ends up with an argument (it may have been written for him, it may have been written by himself—I do not know) which does not help the layman who is fighting an uphill battle against the experts: I can assure you that if I and my predecessors did not believe that our experts were the best in the world, we would not be doing it at all. I know that the Minister is an honest man. But there it is. First of all, he says that perhaps it was not due to the fluoride. We say that perhaps it was, and that we are trying to find out from the Nairobi dentists. The next thing he says is that there would not be all that much fluoride, and nobody is going to add the amount that was contained in the Nairobi borehole. But we, the public, must know what elements of risk 139 there are if there are any risks. I am prepared to be reassured: it is a matter of a balance of judgment. The principle which I think we must adopt on this question of risk-taking is this: if you are going to take a risk which affects you yourself, you are entitled to take a very high degree of risk, but if you are going to impose a risk on others, it must be so small as to be almost imperceptible. This principle has not always been adopted by those in authority.

I am not quite happy about what I think is called creta præparata in bread. I am not quite happy about all the food additives which are allowed, although they are generally all right. But as a completely non-scientific layman I would say to those advocates of the fluoridation of public water supplies at this moment, and with the greatest respect, obviously, for the sincerity and knowledge of the great authorities such as the noble Lord, Lord Cohen of Birkenhead, who has spoken so eloquently this afternoon, that there seem to me to be rather too many sincere and knowledgeable people who at this moment are against this step. I am afraid that it will be necessary to wait a bit. Incidentally, that is what my own county council has said; and it is also what the City of Bristol, which is supplied by my waterworks company, has said. I believe that this attitude of "Let us first hear a little bit more about it" is perhaps the attitude of the general public at this moment: and, as so often, perhaps the general public are right.

§ LORD ROWALLAN

My Lords, I do not wish to detain your Lordships for very long at this late hour, and I am exceedingly grateful for being allowed to butt in like this. I live in Kilmarnock and many of us there were proud indeed when the local authority was among the first in the country to accept fluoridation. The results exceeded all that we could have hoped, as will be seen from the figures in the report. A few years ago, in fact from the time since the fluoridation was introduced, a constant campaign was carried on against it, with the sort of arguments which we have heard from the Floor of this House to-day. Unfortunately, to the regret of many mothers of young children, and (I think I am right in 140 saying) of the whole of the medical profession, that decision was overturned, to the great disadvantage of the children who are growing up in the area to-day.

Perhaps I may be allowed to digress for a short time, on behalf of my fellow dairy farmers, to refer to the strictures by the noble Baroness, Lady Summerskill, on their backwardness. I am sorry to have to say this in her absence, and I hope that she will excuse me. At the time of which the noble Lady was speaking the techniques of pasteurising were exceedingly elementary, and much milk sold as pasteurised from very unhygienic quarters and produced by very unhygienic means was finding a ready market, when in fact the pasteurisation was completely ineffective. All that had been done was to destroy the lactic bacteria which would normally have given notice, by smell and taste, of the ineffective methods which had been used to make it, so-called, safe. I am very proud of the fact that Rowallan was, I think, the first property to be wholly attested. I think that the liquid creamery which we ran was the first creamery in the country to pay on bacterial count. That was well before the last war. We did not receive at the time, either from the Government or from the medical profession, the support to which we thought we were entitled. Far too much emphasis was placed on pasteurisation, and far too little on hygienic methods and tuberculin-testing to eliminate disease. So I do not think we can altogether be blamed for being against pasteurisation and against the efforts being made by Her Majesty's Government on behalf of others, when we were at least as keen as they were and felt very strongly that we were setting about the matter from the right end.

I thank your Lordships for allowing me to intervene. I must apologise if I have to leave, but this is Australia Day and I have been invited to go along to the reception of the High Commissioner.

§ LORD STRATHEDEN AND CAMPBELL

My Lords, I had not intended to intervene in this debate. In fact, when I came up to London I expected a very different kind of debate to take place. But as this debate has gone on I have realised more and more the implications of it in regard to my position at the 141 moment. I speak now as the convenor of a county council in Scotland which is in the process of putting in a county water supply, and which is being pressed to install fluoridation. I should just like to impress on the noble Lord who is to reply that the points raised by my noble friend Lord Waldegrave are exactly the questions which are being put to me and to the chairman of the water committee on the county council. They are very difficult questions for a layman to give a proper reply to, and it would be of enormous help if we could have a really authoritative statement which would clear the minds of all those perfectly genuine people (they are not conscientious objectors or anything like that) who are sincerely worried about what the long-term effects may be. I hope that some of those problems may be cleared up in the Minister's reply to the debate.

§ LORD NEWTON

My Lords, I had not intended to intervene in this debate, either, but your Lordships may recall that in his speech my noble friend Lord Waldegrave referred to me and said that he thought I had been rather unfair in interrupting the noble Lord, Lord Douglas of Barloch, when I did. I shall come to that in a moment. As to Rapaport and mongolism, I thought that that aspect of this matter was so effectively dealt with by my noble friend Lord Cohen of Birkenhead that it would be presumptuous of me to add anything to it.

The first thing I want to say is that we are very much indebted to the noble Lord, Lord Douglas of Barloch, for enabling my noble friend Lord Cohen of Birkenhead to treat us to the terrific rebuttal which he did of the very cause which the noble Lord, Lord Douglas of Barloch, was concerned to advance. I think that this House, and, indeed, the country as a whole, are greatly in the debt of my noble friend Lord Cohen of Birkenhead, and I should have thought that the best way of satisfying the doubts to which my noble friend Lord Stratheden and Campbell has just referred would be for people feeling doubts to read the speech of my noble friend Lord Cohen of Birkenhead when it is published.

The reason why I interrupted the noble Lord, Lord Douglas of Barloch, twice, 142 and I hope with reasonable courtesy, was simply that it seemed to me—and I think it also appeared to other speakers in this debate—that he was impugning the intellectual integrity of those who now work, and who have in the past worked, for the Ministry of Health. I hope that, as a result of this debate, he will hesitate before he says the same sort of things again. Some of your Lordships may recall that for some years I spoke on behalf of the Minister of Health in your Lordships' House—and, indeed, for part of the time I was Parliamentary Secretary in that Department. It was my duty, and indeed my pleasure, from time to time to advocate to people both here and outside the policy of fluoridation. I say it was a pleasure because I believed then—and I still believe—that it is the right policy. I am not concerned to defend my own intellectual integrity, but I think that perhaps I, as well as others, ought to protect the distinguished, though often anonymous, professional advisers in the Department, on whom the Minister relies now, as Ministers have always relied in the past.

My Lords, the third and last thing I should like to say is this. I hope that, also as a result of this debate, the noble Lord, Lord Douglas of Barloch, will use his great influence with the National Pure Water Association to secure that in future they carry on the advocacy of their case with rather different methods. One very good way of doing that, I suggest, would be for them, when in future they send out pamphlets or put them through people's letterboxes, to distribute at the same time copies of the speech made by the noble Lord, Lord Cohen of Birkenhead.

§ THE MINISTER WITHOUT PORTFOLIO (LORD CHAMPION)

My Lords, I am an almost fanatical student of court procedures on television—Perry Mason and the rest—and at this stage I feel very much inclined to call attention to some witnesses that we have had before us to-day—the noble Lord, Lord Cohen of Birkenhead, my noble friends Lord Taylor and Lady Summerskill, and the noble Lord, Lord Amulree—and just say, "I rest my case", and sit down. Unfortunately, I cannot quite do that. I have to answer here for the Ministry of Health, and, of course, I have to 143 reply to some of the points that have been made in the course of the debate and to some of the questions that have been asked.

I must say that I very much welcome the opportunity which my noble friend Lord Douglas of Barloch has given us of having a debate on this subject of fluoridation. The last occasion upon which it was the subject of a Parliamentary debate was on March 2, 1964, in another place. The present occasion we regard as very timely, because in the past six months fluoridation has been debated in almost every forum throughout the country except on the Floor of this House. We have to remember that the decision whether or not to arrange for the fluoridation of the water supplies in its area is in each instance the responsibility of the local health authority, and upon them a great responsibility undoubtedly falls. As the noble Lord, Lord Stratheden and Campbell, said, it is only right that those authorities should have the best guidance that it is possible for them to have when arriving at a decision which is, and must be, full of dangers if some people's feelings on this issue have any substance at all. If the doubts expressed by my noble friend Lord Douglas of Barloch have any justification at all, then of course tremendous responsibility will fall on those local authorities who say, "Go ahead" on the "say-so" of the Ministry of Health and the other experts.

Many local authorities are undoubtedly perplexed by the technicalities of the subject, or confused by the statements of what I am bound to call in this regard a small but vocal element of the community—represented this afternoon, I think, by my noble friend Lord Douglas of Barloch. It is doubly important I would say, in the sense that local authorities will be looking to this House for a lead in this matter, that we should weigh the merits of fluoridation carefully and objectively in the balance, so that those who look to us for a lead may be wisely guided.

The signal for the opening of the present discussion on fluoridation was the issue by my right honourable friend the Minister of Health on August 3 last of a circular urging all local health authorities to make arrangements for the fluori- 144 dation of public water supplies. This followed the discontinuance, with costs against the relator, of an action against the Corporation of Watford claiming a declaration that the corporation, as a water supply authority, were not empowered to add fluorides to the public water supply. I ought perhaps to emphasise here that, in taking the view that a water supply authority had power under English law to add fluoride to the water it supplies, and in commending fluoridation to local authorities, the present Administration had no fundamentally new decisions to take, and that the present Minister's policy, as the noble Lord, Lord Newton, pointed out, follows closely that of his predecessors in office.

From the ensuing discussions in local committees and councils, and in the national and local Press, two important factors have emerged: first, that among local health authorities the weight of opinion is predominantly in favour of fluoridation; secondly, that in many instances the discussions have been conducted in a cloud of doubt and misunderstanding about the basic facts of fluoridation. I should like in a few moments to say something about these two items, but before doing so it would be appropriate for me, I think, to remind your Lordships of the case for fluoridation of water supplies.

§ LORD BOOTHBY

My Lords, before the noble Lord does so, may I just put this point to him: that there will never be any satisfactory solution of the problem of the water supply in this country until it is nationalised—and I thought that was what this Government was all about.

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