Health (Fluoridation of Water Supplies) Bill, 1959—Second Stage.

Question proposed: "That the Bill be now read a Second Time".

The purpose of this Bill is to oblige health authorities to fluoridate public piped water supplies to a level not exceeding one part of fluorine per one million parts of water in order to reduce the prevalence of dental decay —or dental caries—among us. The need to take prophylactic measures against this condition has been pressed year after year by dental surgeons and school medical officers who have drawn attention to the ravages of the disease among school children. And the Dental Caries Survey carried out under the auspices of the Medical Research Council of Ireland in 1952 indicated that the vast majority of children throughout the country suffer from this condition.

A copy of the report of the survey is in the Library. The survey was carried out at the request of my colleague, the Minister for Finance who was then Minister for Health, in order "to ascertain whether there were significant differences in dental condition amongst school children living in different areas of the country and whether such differences, if they existed, could be related to differences in the dietary intake of the children." For the purpose of their work, the surveyors divided the children into three age groups: five to six, seven to eight and 12 to 13 years old. In all, the teeth of over 2,000 children were examined in Dublin city and in a number of towns and rural areas which were taken as being more or less typical of each of the four provinces.

Apart from the depressing facts which it disclosed of the prevalence of dental caries among our children, the Survey furnished information on two questions of great social importance. It showed, first of all, that it was not possible to associate the incidence of dental decay with the intake of certain foods in the different areas as ascertained by the National Nutrition Survey of 1946; and it also showed that its incidence among children did not significantly differ between the different areas covered.

As to its main purpose the Survey revealed that in the group of children between five and six years old only 4.3 per cent. were entirely free from dental decay, while 68.2 per cent. had five or more deciduous, or first teeth, either decayed, missing or filled. The number of decayed or missing deciduous teeth even at this tender age, represented 36 per cent. of the total number of teeth developed so far. In fact, an average child at this stage of life had only about two-thirds of his or her deciduous teeth unaffected by caries. Even the state of their permanent teeth was not good; for almost 18 per cent. of them were already decayed.

As regards children in the next age group—seven to eight years—it was found that only 1.4 per cent. were entirely free from dental decay in their deciduous and permanent teeth; and 41 per cent. of the deciduous teeth were decayed and 6 per cent missing. Of the permanent teeth which had erupted at that age, about 25 per cent. were already decayed or missing.

Only 0.9 per cent. of children in the age group 12 to 13 years had teeth entirely free from dental decay, and only 1.2 per cent were entirely free from dental decay in their permanent teeth. Of the deciduous teeth which might still have been extant at this age, less than 55 per cent. were sound and the remainder were decayed or missing. As regards their permanent teeth, over 25 per cent. had already been affected by dental decay or were missing and this as early as 12 or 13 years old. Now, I would like to stress the findings among this group, the oldest of the children examined, as they show the position among those who are approaching the end of their primary school career. Only 0.9 per cent., I repeat, were entirely free from dental decay; only 1.2 per cent. were free from dental decay in their permanent teeth; and 25 per cent. of all the permanent teeth examined were either decayed or missing.

I think the Seanad will agree that the survey exposed a situation which was deplorable indeed. Unfortunately, however, there is no reason for thinking that the position today is any better; it is quite likely to be worse, and as for adolescents and young adults, it is to be expected that among them the position is worse than among school children.

Though the incidence of dental decay in this country is very high, very high indeed, the available statistics show that the condition is a universally serious problem in all advanced western nations. For example, a recent dental survey from Scotland reveals that despite the free dental services available to all children under the national health service there, the condition of children's teeth has worsened in recent years. A typical Scottish child of five years old is said to have about seven of his 20 teeth either decayed, filled or already extracted.

In New Zealand, 99 per cent of recruits aged 17 to 23 years performing their compulsory military training a few years ago had experienced dental decay and, on average, each recruit had 22 decayed, missing or filled teeth.

On this point, the report of the Expert Committee on Water Fluoridation of the World Health Organisation has this to say:

Dental caries is one of the most prevalent and widespread diseases in the world. It is not restricted to any specific age, sex, or economic status, nor is it peculiar to any country or race. In countries where dental surveys have been carried out, it has been found that almost the entire population is affected by dental caries and its consequences. It has been found, too, that dental caries starts soon after the eruption of the deciduous teeth. Numerous studies have been made on the prevalence of caries among children in many countries, and it has been shown repeatedly that the average child reaching school age has many carious teeth. The consequences of the disease can be particularly serious both in childhood and adolescence. The carious lesions increase progressively in size, frequently leading to considerable suffering and eventual loss of teeth. The consequent reduction of function may affect nutrition in the growing child. Impaired mastication is the direct cause of digestive disorders, and secondary infection from a septic mouth may have far-reaching effects on general health. Not least among the unfortunate consequences of the loss of teeth caused by dental caries are traumatic occlusion, which can induce severe parodontal disease, and the serious psychological and social effect of facial disfigurement. Throughout the world, dental decay represents an economic drain upon both health services and individuals. It would be extremely difficult to assess the amount of efforts spent over many years in various countries to attempt to relieve this disease.

And these views have been echoed recently nearer home. Addressing the annual dinner of the Irish Dental Association last week, the outgoing President, Mr. D. Gogarty, said:—

The number of man hours actually lost to industry in this country through dental reasons is extraordinarily high. Proportionally, it is higher than in England although we cannot afford it to the same extent. But what is even more difficult to assess is the vast number of potential man hours lost through inefficient application of skills, which inefficiency is in turn due to a state of poor dental health.

There is absolutely no doubt that a man bedevilled with aches and pains in his teeth cannot work efficiently. There is no doubt that a man whose abscessed roots are oozing purulent matter constantly into his alimentary system cannot operate at peak efficiency. And there is further no doubt that these circumstances apply more in Ireland than in many other countries.

Some critics of the proposal in this Bill have argued that the problem should be tackled by expanding the facilities for treating the disease. I do not dispute that an expansion of treatment facilities is desirable, but it must be recognised that there are definite limitations in regard to the availability of dental personnel which, of course, seriously circumscribe our potentialities in the field of treatment. The Expert Committee of the World Health Organisation, which I have mentioned, had this to say on that point:—"Early detection and treatment of dental caries is effective in controlling the disease and its results"; but then they go on to add "Even in those countries with the highest ratio of dentists to population, however, no more than one-third of the needs of the people in this respect are being met."

The number of dentists in this country (about 620) is, proportionate to population, about one-third of the number in countries like Sweden and U.S.A. We would, therefore, it seems, have to increase the number of dentists here nine-fold to be able to tackle the problem adequately on a treatment basis. With the financial and educational resources at our disposal now and for a long time to come, this is obviously out of the question. All this apart, I believe, and as I am sure the Seanad will share the view, that prevention is better than treatment, particularly when treatment will not reverse the process of decay. And as to prevention, even its critics concede that fluoridation is a most effective means of preventing caries. They could not in honesty do otherwise, since several independent and reliable surveys extending over periods of years, have shown this quite conclusively.

No responsible person now contests the fact that water containing about one part of fluorine per million parts of water, if ingested from infancy and throughout childhood, inhibits dental decay among children by up to 65 per cent. Thus the prevalence of dental caries among children reared in a community served by public water supplies containing fluoride at the level I have indicated may be as much as 65 per cent. less than in communities served with water supplies containing no fluoride or, as is the case generally in this country, only insignificant traces of the mineral.

Controlled fluoridation studies have also shown that no ill effect of any kind is caused by water fluoridated as proposed in this Bill. An example of such a study is that which was made at Newburgh, New York, in which the adjacent town of Kingston was used as a control. The water in Kingston was not fluoridated; but the water in Newburgh was. Comprehensive medical examinations were made of the children in both towns. These clinical examinations included medical history, a general physical examination, measurements of weight, height, and circumference of the head and chest; vision; examination of the ear, nose and throat; measurement of hearing; and an assessment of physical development at successive examinations. X-ray examinations were carried out of the right wrist, both knees, and the bone density. In the final examination the lumbar spine was X-rayed. Originally 500 children in each city were selected and these were added to in later years. The total number of children examined in Newburgh was 817 and in Kingston 711. The medical examinations mentioned were carried out each year on each of the selected children. As a result of this very thorough study—and I think it will be admitted that it was a very thorough study—it was stated that "no difference of medical significance could be found between the two groups of children".

A report was published about a year or so ago on the results of fourteen years' experience of artificial fluoridation at Brantford, Ontario. It showed, in detail, the beneficial effects of fluoridated water on children's teeth in the age groups nine to eleven and twelve to fourteen years. They were quite remarkable. Having reviewed them the report went on to say: "No untoward effects which might be attributable to the presence of fluoride in the water supply have ever been reported by the medical profession in either Brantford or Stratford". Stratford, Ontario, is remarkable for the fact that it is a town with a naturally fluoridated water supply of 1.6 parts per million of fluorine. We can see from the results of this study that no ill effects of any kind, which might be attributable to fluoridated water, have ever been reported either in Brantford, during fourteen years of artificial fluoridation, or in Stratford, Ontario, where nature has endowed the water with 1.6 parts per million of fluorine.

In fact the truly significant fact that emerges from the welter of controversy is that the harmlessness of fluoridated water on the general health of people has been endorsed by the very many most reputable and authoritative bodies who have studied this subject in recent years. These include our own Fluorine Consultative Council; the Expert Committee of the World Health Organisation to whose report I have already referred; the British Medical Research Council; the New Zealand Commission on Water Fluoridation; the Royal Swedish Medical Board, and various other organisations such as the American Medical Association, the Canadian Medical and Dental Associations, and the Public Health Committee of the British Medical Association.

The opponents of fluoridation seek to convey the impression that medical opinion is seriously divided on the question of whether fluoridation involves a danger to health. It may be that some few medical men oppose it, but, against these, the remarkable thing is that so many authoritative medical organisations have unequivocably endorsed the safety and efficacy of fluoridation as a measure for the prevention of dental decay.

My predecessor in office, Deputy T. F. O'Higgins, appointed the Fluorine Consultative Council to which I have referred in January 1957, to consider "whether with a view to reducing the incidence of dental caries, it is desirable to provide for an increased intake of fluorine, and, if the Council considers it so desirable, to advise as to the best method of securing such an increased intake and as to any safeguards and precautions necessary." This Council comprised 17 persons, specially selected for their ability to assess the different aspects of this matter. In May, 1958, the Council furnished its report to me. In it the Council unanimously recommended—and I stress the word `unanimously'—the fluoridation of public water supplies to the level of one part per million of fluorine in the following terms:

38. Having considered all the information available to it on the relationship between fluorine and dental decay the Council is satisfied that an increased intake of fluorine will reduce the incidence of dental caries and that it is desirable to provide for such an increased intake. The Council is further satisfied that the increased intake of fluorine can best be provided by the fluoridation of public water supplies to the level of 1.0 part per million F. In so recommending the Council is aware that not quite 50 per cent. of the community would thereby benefit at present even if all public piped water supplies in the country were fluoridated but the percentage will increase according as public piped water supplies are extended.

39. Before any public water supply is fluoridated the Council considers that steps should be taken to assess the incidence of dental caries in children resident in the area served by that water supply. The Council also considers that subsequent to fluoridation adequate steps should be taken to permit a proper evaluation of the results.

40. In so far as the engineering aspects of fluoridation of public water supplies are concerned, the Council sees no particular difficulty in the procedure as the methods employed in the addition of fluoride to a water supply are similar to those in common use for the addition of other chemicals to water. The methods used in the protection of public waterworks workers handling fluoride salts are similar to those used in the handling of other chemicals which may have harmful effects and do not need special description here.

41. The Council is in doubt as to whether local authorities have the necessary statutory authority to add fluoride to public water supplies. It recommends the introduction of any legislation which may be necessary to enable local authorities to discharge this function.

This Bill is being brought in to give effect to the recommendation contained in paragraph 41 of the Council's report which I have just read. Its purpose is to clear up the doubt which was thought to exist as to whether public local authorities have the necessary statutory authority to add fluoride to public water supplies.

The Council devoted a considerable part of its report to examining the possible ill effects of fluoridated water, under the headings of acute poisoning, growth retardation, changes in bones, effect on kidneys, etc., and came to the conclusion that no ill effects on health were to be feared from the drinking of water containing one part per million of fluorine.

In paragraph 27 of its report, the Council say "Fluorides in water at a level of 1.0 p.p.m. have no effect upon the taste, odour, colour or acceptability of water for domestic use. No adverse effects on industrial, agricultural, horticultural or other similar processes due to the use of fluoridated water have been substantiated."

Some few years ago the World Health Organisation set up an expert committee to consider this question of water fluoridation and, having examined water fluoridation from the safety aspect under various headings, said: "All these findings fit together in a consonant whole that constitutes a great guarantee of safety—a body of evidence without precedence in public health procedures."

The British Medical Research Council called together a conference of experts in 1956 as a result of which the following statement was issued:

"The experts agreed in general with the conclusions of the United Kingdom Mission (which examined fluoridation in North America in 1953) to the effect that, despite considerable interest and research there is no definite evidence that the continued consumption of fluorides in water at a level of about one part per million in drinking water is in any way harmful to health, and they consider that if any untoward effect is revealed by future research this is most unlikely to be serious."

The Royal Swedish Medical Board, in recommending water fluoridation in 1958, commented: "In the opinion of the Board the enquiry carried out has shown that fluoridation of public water supplies does not involve any demonstrable health hazards even on prolonged consumption of the water."

The New Zealand Commission of Enquiry said: "No harmful effects on health will follow the fluoridation of water supplies whether in respect of the complaints specifically made before us or otherwise." They further said: "In the proposal to fluoridate water there is no risk of chronic fluoride poisoning."

Bearing in mind these definite and categorical statements, what must be accepted is that the alleged ill effects of fluoridation have been considered by the various bodies which studied this subject and these bodies have endorsed the safety of the practice. Apart from the studies already mentioned by me, the studies included the health of adults in areas with naturally fluoridated water supplies at levels even much greater than one part per million.

Perhaps the best known such study was that of the health of groups of adults, selected at random, living in the small towns of Bartlett and Cameron, in Texas, U.S.A. In 1943, over 100 persons who had been living for at least 15 years in Bartlett, where the natural concentration of fluorine in the water supply was no less than 8 parts per million, and a similar number of adults who had been living for the same period in Cameron, where the water contained 0.4 parts per million, were submitted to medical, dental, X-ray and laboratory examinations. The clinical investigations included a search for evidence of arthritis, raised blood pressure, stones in the urinary and bile tracts, goitre, abnormalities of the heart and blood vessels, etc. Laboratory studies included examinations of the blood and urine. These medical examinations were repeated ten years later in 1953 on the same individuals and, apart from mottled teeth among the Bartlett residents, the result of these examinations was that no clinically significant physiological or functional effects resulting from prolonged ingestion of water containing excessive fluoride were found.

Another way of checking on the harmlessness of fluoridated water was to compare various mortality statistics for 32 American cities which used naturally fluoridated water containing more than 0.7 parts per million fluorine with 32 other neighbouring cities using water with 0.25 or less parts per million of fluorine. These comparisons revealed no significant differences. Furthermore, in Britain, where fluoride is found naturally present in some water supplies, up to a level of four or more parts per million, the British Ministery of Health stated in 1956 that a comparison of vital statistics, including several different causes of death, in high-fluoride and low-fluoride areas revealed no differences "which could be interpreted as indicating any harmful effect on health, nor even a slight pointer to the need for any further studies to demonstrate this."

We in this country are fortunate in that we have come to consider fluoridation at a time when the process has already been the subject of extensive and exhaustive study and practical application over many years. At present over 37 million people in the United States of America drink mechanically fluoridated water, while another 7 million people there live in areas where the water supplies naturally contain 0.7 or more parts per million of fluoride. Over 1 million people in different provinces of Canada are also supplied with mechanically fluoridated water. Three towns in Britain—Anglesey in North Wales, Kilmarnock in Scotland, and Watford in England—have been fluoridated since 1955 or 1956 and certain towns in the following countries have had their water supplies fluoridated in recent years: Australia, Belgium, Brazil, Chile, Colombia, E1 Salvador, West Germany, Japan, Malay, Netherlands, New Zealand, Panama Canal Zone, Sweden, Switzerland and Venezuela.

In considering this question, it is essential to remember that fluorine is a natural mineral element and is found, in chemical combination as fluoride, naturally present as a trace element in the majority of foods—in vegetables, meat, cereals, fruit, fish and tea. So widespread are fluorides that it is prac tically impossible to select a diet which does not contain some trace of them They occur naturally, to a greater or lesser extent, in many water supplies, though in this country, so far as our evidence goes, only in infinitesimal proportions. Indeed an analysis of the fluoride content of forty-two drinking waters in different parts of Ireland, carried out in 1948 by Dr. J. A. Drumm, showed that only ten of them contained fluorides of between 0.1 and 0.3 parts per million. The remainder, including the Dublin water supplies, contained less than 0.1 parts per million. The addition of fluoride to water supplies is, therefore, not the addition of a substance that is completely foreign to water but a supplementing of the amount of fluoride which we already obtain in our daily diet, either in food or water. It is important to bear this point in mind when considering some of the objections raised against fluoridation.

One of the main grounds on which objection is taken to the fluoridation of public water supplies is that it is unethical and, for that reason, objectionable in principle.

Here is what the Fluorine Consultative Council in paragraph 37 of its report had to say on that point:

The Council received representations to the effect that fluoridation of public water was unethical. The main grounds for objection were that it was mass medication, an usurpation of parental rights by the public authorities and an interference by the public authority with the integrity of the human body. These objections were carefully considered and advice was sought and received. The Council is satisfied that there is no ethical objection to the fluoridation of public water supplies within the margin of safety recommended in this report.

That is a concise and very clear statement. You will note that the Council say they sought and received advice on the alleged ethical objections and were satisfied that there is no ethical objection to the fluoridation of water supplies within the margin of safety recommended, that is, at a level of 1 part per million.

Two members of the Council signed the Report subject to the deletion of that paragraph but this, I understand, was not because they believed there were ethical objections but because they felt that the Terms of Reference given to the Council did not permit it to concern itself with this aspect of the problem.

Fluoridation is said to be objectionable because it is "mass medication". This is the usual slogan used by anti-fluoridationists wherever this proposal arises. But is fluoridation mass medication in the proper sense of the term? As already made clear, fluoride is ingested in minute quantities as part of our normal daily diet. Fluoride is not a drug or medicine, but a nutrient. It benefits the bones and teeth and is, in fact, a normal constituent of bones and teeth. The addition of fluoride to water supplies will supplement, only supplement, our normal intake of this element. This, I submit is not medication; the fluoride in fact does not cure any ailment or a defect. It is simply a means of making people's teeth stronger and more resistant to the agents of decay.

It has been argued that whereas it may be desirable to provide for the fluoridation of public water supplies the actual implementation of the process should be left to each local authority to decide. There are very strong and cogent reasons why this matter should be decided by the Oireachtas and not left for determination by each local authority. Firstly, as was demonstrated by the Dental Caries Survey of 1952, there is no significant difference in the incidence of caries between different parts of the country and the need to bring the fluorine content of public water supplies up to the optimum level of 1 part per million exists in all areas. Secondly, if we were to leave this matter for decision by local authorities, it would mean that the very large body of local representatives concerned would have to make the attempt to familiarise themselves with the complex, technical, details of the issues involved. If they failed to spend the time and effort in studying this matter they would inevitably be deterred from taking the action which the situation so urgently demands by the misleading propaganda of opponents of fluoridation.

There are over 80 sanitary authorities—that is, water supply authorities —in this country, including the four county boroughs, the county councils, seven boroughs and 49 urban district councils. Only a little over 1½ million people are supplied with public piped water supplies and of these about half are served by the Dublin Corporation. Moreover several of these sanitary authorities avail of a common water supply. Thus in the Dublin area the Dublin Corporation water supply covers not only the city area but much of Dublin County and parts of Counties Wicklow and Kildare. It will be readily seen, therefore, that if it were to be left to each sanitary authority, or even to each county council or city corporation, to accept or reject fluoridation, serious difficulties might arise in practice.

This is a small country, with a homogeneous population, and members of the Oireachtas are in close and constant touch with local affairs. Many indeed are members of local authorities. I submit it would be an absurd waste of time to have repeated, perhaps at every local level, the prolonged debate which has already taken place in the Dáil on this measure.

For these reasons, I feel it is reasonable and logical for the question of the fluoridation of piped water supplies to be decided by the Oireachtas.

Even when the Bill is enacted the Oireachtas will have an opportunity, if a member should so desire, of discussing in detail the application of the measure. It will be noted that the Bill provides that before regulations are made under it surveys of the incidence of dental caries in the areas to be fluoridated shall be carried out and that the fluorine content of the public water supplies in those areas shall be determined. Reports of both these investigations must be laid before each House of the Oireachtas, as must also the regulations when made. Members of either House will then be in possession of all the facts to enable them to debate usefully any provision of the regulations which in their opinion calls for discussion.

Finally, I come to the question of cost. In paragraph 31 of their report, the fluorine Consultative Council said that the cost would vary with the size of the community and pointed out that in the fluoridation areas in Britain the cost, including allowances for capital costs, varies from about 3½d. to 7½d. per head of the population per year. A recent report about the cost of fluoridation in Watford, England, said that the all-in cost, including materials, maintenance and depreciation of plant, is working out at 4½d. per head per year. It is estimated that the annual cost of fluoridation for our country as a whole will be of the order of £30,000. Half of this cost will rank for recoupment from the Health Services grant. The capital cost of the equipment and its installation has been estimated at £100,000 for the entire country.

I will now refer briefly to the different sections of the Bill. Section 2 imposes a duty on health authorities to arrange for the fluoridation of public piped water supplies in accordance with regulations to be made by the Minister for Health. Subsection (2) of the Section empowers the Minister to fix a time limit for the carrying out of this function. It will hardly be necessary to avail of this power but it needs to be incorporated to provide against unreasonable delay in any area. Subsection (3) which provides for the regulations referred to, also stipulates specifically that the maximum amount of fluorine that may be added to public water supplies is one part by weight of fluorine per million parts of water, which is the level authoritatively endorsed from the points of view of efficacy and safety.

Subsections (4), (5) and (6) provide for the carrying out of surveys of the incidence of dental caries among school children in the areas to be fluoridated and surveys of the fluorine content, or other constituents, of public water supplies in those areas, reports of which are to be laid before each House of the Oireachtas.

Under Section 3 is to be determined the health authority which shall arrange for the fluoridation of a public water supply. Where a particular supply serves the population in the area of two or more health authorities the responsibility as between these authorities for arranging for fluoridation will be determined by the Minister.

Section 4 will enable the Minister to impose a duty on sanitary authorities, who are the statutory bodies responsible for supplying water to the public, to act as agents for the health authorities in the fluoridation of the public water supplies. The expenses incurred by the sanitary authorities will be met by the appropriate health authority.

Section 5 provides, where two or more health authorities are concerned, for the apportionment of expenses between them on the basis of the amount of water supplied to each.

Section 6 imposes a general duty on the Minister for Health to arrange from time to time for such surveys as appear to him to be desirable to be made as respects the health, or any particular aspects of the health, of persons, or classes of persons, in the fluoridated areas. This section was inserted to meet some views expressed in Dáil Éireann. The report of any such survey, which may be carried out through local health authorities or some other organisation or body, must be presented to each House of the Oireachtas.

Section 7 provides for the carrying out by health authorities of surveys of dental caries in their functional areas whenever required to do so by the Minister. Such surveys would among other things be of great value in demonstrating as time goes on the beneficial effects of fluoridation.

Section 8 refers to the Health Services (Financial Provisions) Act, 1947. It is intended that half the current expenditure of health authorities on fluoridation will be recouped to them from the Health Services grant as from the date on which such expenditure is incurred. The necessity for the section arose from the fact that under the 1947 Act as it stood the recognition of a new health service could only have been made effective from the beginning of the financial year following the introduction of the service. The new section will enable the recognition of fluoridation expenses for the purposes of the Health Services grant to be made effective at any time.

Section 9 contains the usual provision for the laying of regulations made under the Bill before each House of the Oireachtas.

We cannot give the support to this measure we would like to give because we believe it is far too complex and difficult a proposal in relation to the various types of water supplies we have. The Minister showed some of the difficulties, but he gave it as a reason for taking the compulsory power in the Bill the number of county councils, borough councils and urban councils in the country. I could add to that that there are a far lesser number of county medical officers and that they over-step the boundaries of the borough council and urban council districts and are in a broader sense the county health officers. It is the advice of these officers that we shall rely on.

The Minister having addressed us on this measure for nearly an hour I feel that some of this fluorine has almost gone into my bones, because the amount which he tells us requires to be injected in order to be of benefit is only one part per million.

This is a chemical which it is necessary for chemists to record, if it is used in prescriptions. Therefore, there must be some reason why people speak against fluoridation. I should hate to think—and I hope the Minister did not mean to imply—that they were a bunch of cranks who went around with sandwich boards creating agitation against those who wish to do good by giving us another new panacea, such as fluoride in water.

The Minister purports to show that there is a far higher percentage than one part per million in many places in the United States. I think in those cases that it is calcium fluoride as it is found in its natural state which would have to be injected generally in the form of gas or liquid in the way town water supplies are chlorinated here. It is not quite the same as finding one part per million by way of chemical analysis.

Before any Order is made under this Bill, surveys will have to be made everywhere to find out the possible effects. In many counties, there may be as many as 10 or 15 different water supplies. It might also be found as the scheme developed that it might be wholly uneconomic to compel the public health authorities in those areas to use fluorine in the water in these small supplies.

There is another problem which should be answered emphatically and left outside the realms of controversy. What effect will it have on our food and drink industries? Many of our exports are concerned with either food or drink. Much of the food is processed and in many of those processes, water is an ingredient in some way. Will the fluorine have any ill-effects on those products? I notice in a report which was sent to me that in Rochester, New York, a local company found themselves obliged to defluorinate the water in order to avoid an injurious concentration of fluorine in their prepared baby foods.

When the Minister asks us to give compulsory powers and when he denies the right of the lesser authorities such as a county council, which would be the authority in a public health district, we have to examine the matter very closely to see if it is right to give him these rather sweeping powers. I know he will say that all orders made under the Bill will be laid on the Table of both Houses of the Oireachtas, but, in practice, there is no system for having these orders examined and reported on to the members of the Oireachtas. The Minister may say it is the duty of members of the Oireachtas to read all the orders, but I believe it would be a far greater safeguard, if it could be demonstrated that it is necessary to have the Orders made beforehand, rather than have them compiled by some of the Minister's officials, submitted to him for signature and then laid on the Table of both Houses of the Oireachtas.

I must say that the compulsion in the Bill is one of the things to which I have most objection. I believe that many public health officers would recommend that the type of water in the area would lend itself to the addition of fluorine, that it has an addiquate amount of calcium in it to absorb the fluorine injected into it by mechanical means, and that their experience and the best technical advice would suggest that it would be best in the area where they are entrusted with the care of the public health. In that way, the interests of all sections of the community would be safeguarded, rather than handing the whole matter over to the Minister and the Department in Dublin.

I hope the Minister will answer the objections I have made to the impossibility of imposing a system on hundreds and hundreds of different water supplies in the country, differing in their chemical and biological content, and the possible effect on our industries which manufacture food and beverages of various sorts. In fact, any industry which uses water either directly or indirectly as a part of their processing methods, will naturally want to be assured that the adding of fluorine to the water supply will in no way affect their final product.

I should like to say a few words in praise of the Bill and to congratulate the Minister for the courage and foresight he has shown in putting into effect the report of the committee set up by the previous Government. I do not wish to make this a political matter but I wonder what the arguments would be, or what line the Opposition would now be taking if their Minister for Health were putting this Bill through the House and hoping to make it a law of the country.

From what I read of the debate in the Dáil and debates in other places, it appears to me that there is opposition for opposition's sake in many cases. Nothing scientific and nothing of any significance was put forward against the Bill in a number of places. Personally, I am shocked at the high incidence of dental caries, as shown in the figures from all over the world given to us by the Minister. I had a feeling that we in this country had a very much higher percentage of that disease than other countries. I find it most deplorable when young people, and even children at school, tell me they have had their teeth extracted. If only from the point of vanity, when we consider the beautiful Irish girls we hear about with their mouths full of artificial dentures, it is itself a terrible reflection on our health system. In other countries I have visited, I have not noticed whether the young people's teeth are missing but these figures of the high incidence of the disease have come as a great shock.

I am very hopeful that when the Minister puts this Bill through the Oireachtas and it becomes law, there will be good results. I know it will take some time and that the scientists will be watching for results and I hope that most of them will be good results. It has been argued that scientists and doctors have not been unanimous but I would like to ask when, if ever, have any group of doctors been unanimous on anything.

Or politicians.

That is true, but we are taken as individuals, while if a doctor speaks, he has spoken and you must accept his word. I happen to know a little bit about this. I have read a good deal about medical science and its development. Going back to the original improvements in science, who treated Mr. Lister in the way he was treated? Not the man in the street but the doctors. All through medical history opposition has come from fellow doctors.

This theory of the ethics of interfering with the individual was used very much at the time of the introduction of anaesthetics. Some people in the Dáil used the ethical argument very strongly. They spoke about the result for individual people and their rights and about this mass medication. If any of these persons had to have an operation and held the ideas which prevailed at the time, would he like to be held down by six strong men while his appendix was removed? All developments took place in spite of doctors and, thank God, we are at the present time in a fairly civilized way, in spite of doctors. There have always been enlightened doctors but hardly ever unanimity among them, so that part of it does not distress me much.

There has been talk about compulsion, about making this compulsory for local authorities. That is one of the wisest things the Minister has decided, because, as a member of a local authority, I do not have to tell members of other such local authorities of the utter and complete waste of time and energy that goes on in discussing the smallest matter. In my own county, the vital matter of providing means of transport from one side of the country to the other involved, because two local authorities were concerned, 25 years of waiting for a bridge which should have have been done if an order had been made and they were told to get on with it. So our great-great-great-grandchildren will have no teeth at all if things are not done by compulsion and if caries disease continues at the rate it is going. I congratulate the Minister on his courage and wisdom in making this compulsory. I do not want to spend what is remaining of this term of the local authorities discussing whether we shall or shall not fluoridate the water. I shall be glad to get an order and help to do it with other members of the local authority.

The scientific reports read to us tonight by the Minister are very considerable and I do not think that the people, however they wish to disagree, can ignore the reports of the World Health Organisation. It is accepted that in that body there are some of the greatest scientists of the world. I once heard the Minister say, when putting a Bill through the Dáil, that he would accept only authorities known to be authorities, not self-appointed ones, so I suppose in this case, as in many others, we shall all be appointing ourselves minor or major scientific experts. I want to congratulate the Minister. I hope the Bill goes through the Oireachtas and that, in the future, whatever time it takes, it will show results and that we shall be happy to say: "You were right, Mr. MacEntee."

I should like to support Senator Mrs. Dowdall in her general approval of this Bill. We have to look at it, I think, in two lights: first of all, is it right that we should try to do this, and, secondly, is it necessary? Take it the other way round, if you like, but I shall take it in that order for the purpose of the discussion. The ethics of how far a central authority should go in interfering with the food and drink of the people in general has been a matter of debate for very many centuries. I do not think there is any doubt that the authority has the right to protect the public from disease through impurities in food or disease, through adulteration of food or interference with its natural content.

That has been accepted in many Food and Drugs Acts in various countries and I think it has also been accepted that a Minister or any central authority has the right to publicise, to use all the propaganda at its disposal, to advise the public about foods that would be good for them, about those they should take and those they should avoid. It is only when the question arises of introducing some specific thing into the diet, particularly into an article of diet taken almost universally, that the matter goes, or appears to some people to go, beyond that range of authority and responsibility, but in considering that latter point, we must remember that any central authority has a special responsibility for specific sections of the population.

In the main, you can assume when you exercise propaganda, by advertisements, films and so on, to encourage the public to do this or that about their diet, that adult members of the public will consider these things and act accordingly, but there are children and people who are not in a position to make up their minds, and particularly regarding the younger section of the people, the responsibility of those in authority, those who have certain evidence to look over, has always been accepted as being very heavy.

We have here a fluoridation of water supplies Bill and we must take that in particular relation to the fact that it is children whom we are proposing to protect in order that they may grow into more healthy adults, not having this great handicap of serious dental caries, at least so far as we can prevent it.

This happened in the relatively recent past, the past 20 years. It began during the war when it was realised that the flour in these islands would not be sufficient, that the flour used here and the flour it would be possible to import, would not be sufficient to make enough bread to go around. In order to get over the difficulty in Great Britain and here, it was decided that the extraction rate of flour should be increased. It was realised in Great Britain that this would probably involve interference with the absorption of calcium and therefore that some calcium should be added to the flour in order to make sure that growing children would have the opportunity of forming bones and avoiding rickets.

That was done and there were no rickets in England. In this country it was not done because there was less flour than in England and we had a different extraction rate and in fact, there was greater interference with absorption of calcium and a very serious outbreak of rickets. We did some surveys on this and demonstrated it absolutely beyond doubt. We advised the Department of Health. It took a little while, but eventually the then Minister did add calcium to flour. The result was that the incidence of rickets fell and, after two years, it was back to the level at which it had existed before the war.

That makes me ask the question; would that Minister have been justified in deciding, on ethical grounds, to refuse to add calcium to flour? Children died of rickets in those periods. Many children who did not die were deformed for the rest of their lives. I think that, on ethical grounds, he would have been wrong to have refused to accept that advice.

We must look on this in almost the same sort of way. We have the same sort of situation. The Medical Research Council, as the Minister pointed out, some eight years ago, did this survey at the request of a predecessor of his, and the appalling state was revealed that among children of about 13 years old, 20 per cent of their permanent teeth were carious. Another figure even more appalling, which I do not think the Minister mentioned, was that only four per cent. of these carious teeth had been filled. That, of course, was due to the great deficiency of dentists in the country. The Minister has mentioned that.

I believe that there are at the moment 73 whole-time and 53 part-time dental officers employed by local authorities in this country. Most of these officers are, of course, employed to look after the teeth of school children. It is accepted that we should have about one dentist to every 1,000 school children. We have something like over half a million school children, so that we should have about 500 full-time dentists looking after the teeth of those children. The Minister said that we should have to increase our dentists ninefold, and that is about the size of it.

We would need an enormous increase, and would want to find 300 or 400 more dentists. On the Dental Register in this country, there are about 900 altogether, and the number on the register is slowly going down. We are not producing enough even to keep the number of dentists at the level at which it exists at the moment. This means that, even if the Minister could find the money for the additional salaries involved, we cannot imagine enough dentists being found within the next 20 years to bring the level of dental care in this country up to that required for proper conservative treatment.

It seemed, therefore, that you have no alternative but to do the best you can in the way of prevention, and this use of fluorine is the obvious thing at least to try. Fluorine is, of course, deposited in the enamel of the tooth, and its presence there gives this enamel its hardness. It is deposited there while the tooth is growing. When the tooth is already erupted and has reached its permanent state, it has ceased to take up fluorine and the addition of fluorine then is probably ineffective. Similarly, the addition of fluorine by application to the teeth in the way of tooth paste is, I think, also ineffective, partly for that reason and partly because it is unphysiological. The tissues of the body take up best those materials brought to them in the blood. They utilise it best and form them into new tissues. To apply a material directly is not the way nature has intended it to be done.

We learned that long ago when we tried to treat arthritis by rubbing things on the joints. It was only when we learned of a remedy that could be fed to the joints through the blood and taken by mouth that we were able to cure this disease. When we come to find an effective hair restorer, it will not be found to be effective through being applied to the scalp. It will be found to be effective by being taken by mouth or by being injected.

I think that in this case we have no alternative to passing this Bill. In fact we would be failing in our duty as people who have studied this matter and learned the lessons of other places where experiments have been carried out, if we did not pass this Bill. The Minister set up a Commission that studied this matter for, I think he said, over a year. His Department presumably has studied it in the intervening two years. The Medical Research Council has given it considerable consideration and many other bodies have made pronouncements. We have all this information, and if we cannot make up our minds and say that this is something which it is our duty to do, then we are just passing the buck. It is not sensible, and we are leaving ourselves open to what the Minister mentioned, the susceptibility of people who have not had an opportunity of considering this matter, to propaganda which is not always advisable.

I remember well that when the British Government were considering the addition of calcium to flour, there was a centre from which a lot of propaganda issued, to the effect that this was wrong. It was going to cause people blood pressure, to make their arteries harden and their kidneys to fail, and all kinds of other dire results were prophesied. There was a name always associated with this propaganda—a doctor's name—and he was described as the Director of Research for the Prevention of Diseases. There was no substance in any of the things he stated, and when somebody took the trouble to find out about this research institute in the prevention of diseases, it was found that he was the director of it but he was also the entire staff. He had done one experiment a long time ago and had done nothing else except propaganda. He was prepared to examine people who were afraid of their blood pressure going up because they were being forced to eat this calcium in the flour, and afraid of their arteries hardening and their kidneys failing in their functions, and all these had to be tested periodically. I think there was an ulterior motive.

I do not say that that is the sort of thing that is happening with the anti-fluoridationists, but I feel that if we have considered this matter and if we feel that this is the right thing to do, we should do it. We should not pass it on and leave it open to other people to decide, when perhaps they are not able to give it as much attention as has been given to it hitherto. I therefore support this Bill.

I think that in nothing more than a Bill of this kind is the Minister for Health fulfilling his function best as Minister for Health, because whatever views we may have on the Bill, the purpose of it is clearly to promote good dental health among the population of this country, and the Minister this evening was particularly happy in the role which this Bill gives him an opportunity of fulfilling. I am sure he has derived great comfort from the very learned and lucid speech just made by Senator Jessop. It seems that whatever stigma attaches in this House, even to this day, to university professors in the eyes of the people opposite has been removed by his learned contribution this evening.

I was, I must say, extremely interested in the statistics given out by the Minister and like Senator Mrs. Dowdall, I was amazed to find that dental caries was so widespread in other countries, but there is one set of statistics which I should have wished the Minister to give. Perhaps he has not got them or they are not available. Maybe he gave them at a time when I was not listening. If that is so, I regret raising the matter.

I should like to know the distinction between the incidence of dental caries among children in rural and children in urban areas. It would probably throw some light on the situation. Do I gather from the Minister that there is no difference?

The report of the survey indicated that there was no substantial difference between the incidence in one area as compared with another, rural or urban.

There is a growing tendency among young people to eat ice lollies and things of that kind and I understand from dentists that these ice lollies have a very deleterious effect on the teeth of young people. Indeed, I wonder whether, instead of a Bill of this kind, we should not pay more attention to the prevention of the use of this kind of thing which may have a positive deleterious effect on dental health among young children.

I am given to understand also that ice lollies and things of that kind, of which children are so fond, are in some measure responsible for the incidence at particular times of the year of poliomyelitis. That may not be so, but it is a matter upon which I should like the Minister's comment because there exists among quite a number of people the view that these things are not good for children or children's teeth.

There is another aspect of the problem to which I should like to direct the Minister's mind, if I may. This Bill concerns only piped water supplies and the Minister has stated that there is no difference between the incidence of dental caries in rural and urban areas. The effect of this Bill will be that the children in urban areas will enjoy better dental health than the children in rural areas. Has the Minister any plan in mind to improve the dental health of children in rural areas? Has the Minister in mind any scheme of propaganda, the effect of which would be to develop a consciousness of the desirability of cleaning teeth and of having teeth regularly examined of children living in rural areas?

If we are not doing that, if there is not such a scheme in contemplation, we are not being fair to the children in rural areas who can never have the benefit of fluoridation in the water which they will drink. I think that aspect of the problem of dental caries is one which should immediately engage the attention of the Minister and his Department.

We hear about the number of university graduates who are emigrating and I am sure that among that group there are as many dentists as there are others. We suffer so hopelessly from the shortage of dentists in this country that I wonder whether the Minister is taking any positive steps to increase the number of dental students and encourage young boys and girls to take up dentistry as a subject or as a career, because if he is not, it is quite clear that, for half the population dental caries will continue to be a problem and there will not be anything like a sufficient number of dentists available to deal with the problem of that half of the population.

Certain objection has been taken to some people raising ethical objections to this Bill. I am all on the side of the people who question the propriety ethically of a Bill of this kind. I am all for that and I think they are the people who ensure that inroads are not made upon the personal liberty of the citizen. I think what the Minister said and what Senator Jessop stated with regard to the addition of calcium to flour during the war years laid my fears on the ethical basis somewhat at rest. I think a case has been made out for the introduction of fluorine into water. It seems to be as proper a thing to do as introducing any substance to make water pure and fit for drinking. As a result of the statements made by the Minister and supported by Senator Jessop, my fears to some extent, from an ethical point of view, of this kind of measure have been quieted, but I would urge the Minister to pay some attention, if the problem is as great and as telling as it is, to doing something in relation to the children in rural areas.

It always strikes me as being extremely odd that in country schools at 3 o'clock in the afternoon, there is no more light than there is in a school in the city. I do not suppose that there is one out of 100 schools that has any form of artificial lighting. The children in country schools have to sit down and read the print in books or on blackboards with inadequate lighting and, at the same time, we have a public health service with doctors going around examining children's eyes, prescribing glasses and cures instead of responsible authorities preventing the disease and providing the cure in advance. I am rather inclined to think that this Bill is something in the same form as the service we provide in relation to the vision of children in our schools. I hope that, once this Bill has been introduced and that water has been fluoridated, the Department of Health and the local authorities will not say: "That is an end of the problem of dental health among the young children attending the schools."

Finally, there is an observation I wish to make in relation to subsection 4 of Section 2. It reads:

Before making regulations under this section, the Minister shall—

(a) cause to be made—

(1) a survey of the incidence of dental caries in a representative sample of pupils attending fulltime day schools in the functional area or functional areas of the health authority or health authorities to whom the regulations relate.

The Minister, I am quite sure, will agree that no health authority and no Minister can cause any child to appear before it to have its teeth examined in any survey. I wonder whether the constitutional position of the parent and of the child is properly safeguarded by the proviso in subsection (2) of Section 7? I wonder if it is intended that that should relate——

Would the Senator look at Section 2 (6)? He will see a very full reservation there.

The Minister has adequately taken care of the constitutional position. I beg his pardon—I did not see that.

The Senator, I understand, is also trying to do that in another place.

I have a recollection of a previous Bill, quite different from this one, the Greyhound Racing Bill, which was before us in 1957. The Minister unburdened himself of his view of what attitude the Oireachtas should take regarding the constitutionality of its own legislation. That view did not commend itself to me. Having read subsection (4), I began to wonder whether the Minister's views on the Greyhound Racing Bill were not carried into this Bill. However, I do see some kind of safeguard in Section 7 and I am glad the Minister is so much alive to the Constitutional position of parents.

I listened with great interest to the Minister when he was introducing this Bill, and I have read, I think, most of the debates on the matter in the Dáil. Despite a good deal of pretty strong attack there, the Minister can be congratulated on presenting a case very expertly and urbanely. There is no question that he has made himself familiar with the subject. I suppose most of us here are laymen and in some respects we are in the hands of the experts. It is the privilege of the laymen, however, to put questions to the experts. In my experience, if the expert gets annoyed on being questioned, then he is not quite sure of his ground. If he answers calmly, the chances are that he knows what he is talking about. My tendency, then, would be to put certain questions and to make certain objections to this scheme from the point of view of a non-expert who has read something about it and done a certain amount of thinking.

The Minister quite rightly stressed, both here and in the Dáil, the incidence of caries in teeth—children's teeth in particular—in this country and the dangers involved. He quoted at a good deal of length the W.H.O. report which talks about the dangers and the disadvantages of widespread dental caries. He is certainly right to do that, and to be disturbed about it. He made a point, incidentally, which seems to warrant attention; I am sure it is true. He quoted this extract from the W.H.O. Report as reported at column 274 of Volume 184 No. 2 of the Official Report of Dáil Éireann. He stressed the effect of bad dentition on

—digestive diseases and secondary infection from a septic mouth [which] may have far-reaching effects on general health.

That is a point that must be made, and is certainly sound. Yet it is slightly disconcerting to find—and it is the sort of thing one finds implicit in other reports also—that as reported at column 283 of the same Dáil debate, when the Minister passed on to a consideration of two adjacent towns with similar situations, one of which had fluorine in the water and the other of which had not, no apparent general health benefit accrued to the town blessed with fluorine. The relevant extract reads as follows:

The Bartlett-Cameron survey, a 10-year longitudinal study of 168 individuals, demonstrated no adverse health effects with even 8 p.p.m. in the drinking-water, although tooth mottling and a low incidence of osteosclerosis were found. Mortality and morbidity rates are comparable for fluoridated and non-fluoridated population groups.

I do not know whether the Minister sees the point I am trying to make there but it seems slightly disconcerting to find that despite the fact that a population with pronounced dental caries is prone to all kinds of digestive disorders and bad health of every kind, nevertheless when you compare the two towns as far as mortality and morbidity go, they are apparently much the same.

The Minister makes the point that in this case one particular town has a big intake of fluorine—eight times what is proposed here—yet that does not seem to have any adverse effect on the mortality rate. Apparently, though, the taking of fluorine has not had any beneficial effect either on the mortality rate. From the general health point of view, it is almost as if it did not matter whether you took it or not.

Our own Consultative Council say in their report at paragraph 25, page 10:

Mortality statistics show that there is no significant difference in the general death rates between areas where fluoride is present and those where it is absent....

I should have rather expected the contrary, for I am prepared to accept the view that fluorides absorbed in the early years make for better teeth, and that better teeth make for better general health. Therefore, I should expect to find better general health in a community which had had the benefit of fluoridation. Yet, apparently, mortality statistics show that as far as that goes it is much the same. I merely comment on the fact that it seems strange that the mortality statistics are not better where they have had the benefit of fluoridated water.

When I look at this country and hear the Minister talk about dental caries in children, I am quite sure he would share my view that dental examination in our schools (a) is not half frequent enough and (b) when it is uncoupled with dental treatment, it is almost worse than useless. I am afraid we are a little complacent or apathetic about this. The children's teeth are examined, I suppose, once in three years, and what should be done is noted. Actually, I am afraid that in a large number of cases, they are simply neglected. As well as fluoridation, if we accept it, we should be active also in promoting dental hygiene among children. The point has been made by Senator O'Quigley in relation to what they should eat and should not eat—the question of the eating of sweets and all kinds of things, which I think is not perhaps properly taught in our Irish schools, and this failure contributes to a state of dental decay which will not be entirely met even if every child in the country could be given the right optimum dose of fluorine.

Now, there is no question but that the picture of the prevalence of dental caries presented by the Minister is substantially accurate; though a point revealed in the council's report is that the statistics and percentages quoted by the Minister are based on a sample of only 2,000 Irish children. Two thousand children out of something like 600,000, say, up to the age of 12 or 14 is rather a small sample, but the chances are, nevertheless, I concede, that the result is pretty representative. Despite the fact that it is dangerously small, if one wants to prove something in general, I am prepared to accept what the Minister says, though there might be small disparities in his percentages.

It is also true, however, in relation to the heavy incidence of dental caries that our dental services are disgracefully inadequate. I do not think we should be allowed to salve our consciences in relation to dental caries in Irish children, by simply saying: "We will pass this fluoridation law, and in five years' time, a certain proportion of those children who have the benefit of tap water in their houses will be considerably better off." That is not good enough and I believe with Senator O'Quigley that we must tackle this grave problem a bit more radically than that.

It is known that in Britain, when, after the War, with the extended health schemes the dental services were made available freely to a far wider section of the community, they were actually swamped out with what you might call a backlog of dental decay to cope with. That is what would happen here, and what ought to happen, if we were really doing our duty in this matter of dental caries. I am prepared to accept from what I have read, and from what the Minister has referred to, that the absorption of the right amount of fluorides of one kind or another does quite definitely reduce the incidence of caries. It reduces the incidence because it is a preventative, and I do not think that point can really be argued. We can grant them that it has been proved that through the absorption of fluorides in the right quantity the percentage reduction is so considerable that you cannot argue about it.

The W.H.O. report which the Minister made available in the Library makes that point in a very balanced way, and I do not think you can have a legitimate argument about it. It was also clear from the report that the major beneficial effect of the absorption of fluorides, and I am sure the Minister would accept this, is up to the age of about 12. I do not deny that there may be some slight beneficial effect after that—some say up to the age of 15 or 16, and some even say that there is a perceptible effect up to 20 and even 40, but that is not regarded by the experts as proven. I should also like to observe that the W.H.O. report lays stress all the time on the necessity for the dose absorbed being the optimal dose. The dose has to be very strictly within certain limits. It is not good enough, if it is too small; it is dangerous, if it is too big. "The optimal dose"—that is the phrase they use, and the phrase which in fact the Minister quoted in the Dáil, when quoting from their report.

Our own Consultative Council went into the matter in regard to Ireland basing their findings, I think, largely upon statistics from outside this country but doing it in a conscientious way and quoting their sources. I would have been happier if they had gone more deeply into Irish conditions and the likelihood of the correct dosage reaching the majority of our children and so on, but on the general principle, the report is obviously a sound one.

The Minister has also referred to the Swedish report which I have here, the Swedish medical report on the whole question by a distinguished body of doctors who reported to the Swedish Government and reported in favour of controlled, and very carefully controlled, fluoridation of water. But there were dissentient voices and they are quoted in the report. I should like to quote one passage because it has been suggested that the experts were all agreed in the Swedish report that there should be flouridation. The politicians got at it in the Swedish Parliament, we are told, and did the experts down. I should like to quote this passage as an illustration perhaps of one factor prompting the decision of the politicians in the Swedish Parliament not to accept the recommendations of this body. This is on page 5 of the report and it deals with the special statement by Dr. Strälfors, and I quote:

Dr. Strälfors views can be summarized as follows:

—that is his views regarding the efficiency and safety of water fluoridation. He expressed criticism against several of the American investigations on which water fluoridation has been largely founded——

In the large clinical investigations on the effect of water fluoridation no attempt was made to devise a randomization procedure, which would have eliminated bias on the part of the examiners. No estimate was made of the method of error, i.e. the variability between examiners and between inspections of the same examiner. No statistical evaluation of the final results was made in the Grand Rapids, Newburgh and Brantford studies.

—which the Minister quoted—

The claims concerning the amount of caries reduction are therefore open to doubt. The effect of fluoridation, if any, was a delay of caries during childhood. There exists no valid proof of any influence on dental caries after the age of 20.

Water fluoridation gives a highly variable dosage—

—and, to my mind, that seems to be a valid criticism—

—because of the great variation in individual water consumption. The intake of fluorine with food is also very variable. To this has to be added that there are large differences between individuals in their sensitivity to fluorine. There is no safeguard against toxic injuries to some of the people in a fluoridated area.

I think that type of statement by one of the responsible Swedish experts, although he is in a minority in that particular case, was a factor in the hesitancy shown by the Swedish Parliament to adopt the recommendations; and, in fact, they turned them down. Similarly, in the city of New York—I hesitate to quote this because I am afraid the Minister was not impressed in the Dáil by the quotation——

May I beg the Senator's pardon? Before he passes from that point which he has just made about Dr. Strälfors, he is reading, I think, from this version of the Swedish report which I have. Would he turn to page 7 and read the second paragraph because it would save time? I might not have to reply if the Senator would read the second paragraph.

I am prepared to do that, but I think on the whole I might be allowed to do it in my own time. I think I made it clear that Dr. Strälfors' view was not accepted by the Committee as a whole——

They passed some strictures on his methods——

Just as he passed some strictures on those of other experts. The point I am really making is to explain to some extent why the Swedish politicians hesitated to implement the recommendations of the report.

Again, the Commissioner of the City of New York Department of Water Supply, Mr. Arthur C. Ford, made a statement, some of which was quoted in the Dáil; and there are matters in it to which reference must be made. I am prepared to concede that Mr. Ford, although he has a great deal more knowledge than I have, could not claim any more than I could to be an expert on the question or to be a scientist in any sense, but he has his expert advisers.

He said in the second paragraph of this document which was issued in April, 1956:—

The Department has extensive laboratories staffed by reputable scientists and competent sanitary engineers with a massive library, in which are contained over five thousand references on the subject of the fluorides alone. We have continued to study and evaluate the effect of toxic substances as related to water supplies. The matter of fluorides has been under our scrutiny for over twenty years.

I do not think that can be brushed aside and I do not think we can regard New York as being just a hick town which is not well up in science or not in the forefront of the scientific world.

We must pay attention to what is said by such a man and to his stated reasons for the decision. He goes on to say—and I think this is relevant to those who say: "After all, you do not object to chlorine, so why object to fluorine?":—

No one has suggested that dental caries is a water-borne disease or that water is a cause of dental decay.

It is suggested, of course, that typhoid is a water-borne disease, and that you may have to combat in the water something that otherwise would be absorbed with the water. There is a sharp distinction between putting chlorine into water to combat a water-borne disease and putting fluorine into water to combat something that is not in the water at all: dental caries.

He goes on:

No satisfactory reason has ever been advanced to show why everyone in a community must be compelled to risk life-long extraordinary exposure to the toxic action of fluorides, particularly when safer, more effective and more economical ways of administering fluorides for caries reduction in children's teeth have been pointed out and are available.

That is of extreme importance to us, if we accept the view, as I do, that the administration of fluorine is beneficial and worthwhile. We must pay attention to the fact that a man in his responsible position says that there are "safer, more effective and more economical ways of administering fluorides."

He says further:

We are aware that the fluorides are extremely toxic substances, and evidence exists to show that even at the recommended level of one part per million of fluoride in drinking water...

—and that is what is proposed here—

... people in fluoridated communities have been harmed. A very small percentage among a population of eight million, sensitive to the chemical and adversely affected, would constitute a seriously significant number of persons harmed.

Later on, he says:

Because of this, and for reasons of safety and economy, this Department has proposed that the City distribute fluoride tablets through health stations, free of charge, for parents to administer to children. The cost to the City ascertained at less than 25 cents for a thousand days for each child, would be less than one-fifth of the cost of a fluoridated water programme. Tablets (a pharmaceutical grade in contrast with the commercial by-product used in water fluoridation) would provide an exact procedure, under control, to be taken only by those during the formative period of their teeth.

Again, we cannot leave this aside, and say he is "only a Commissioner," that New York is unimportant, and he is not a scientist. What he actually says is extremely cogent.

He continues:

Fluoride, besides being a toxic substance, is not all excreted when taken into the system, a significant percentage remaining cumulatively.

That is relevant, if we are to have an adult population taking it indiscrimately for 30, 40 or 50 years.

He goes on:

Fluoridation of the drinking water at any level of concentration is a very indiscrimate procedure since children drink widely varying amounts of water...

The last part of this report which I want to quote reads:

The problem of managing the control of dosage of fluoride chemical to obtain uniformity—

—and it is essential where we are concerned that the optimum dosage shall be uniform—

—throughout a grid-work of more than 5,000 miles of pipe and tunnels involving different sources and pressure gradients, as in the New York system, is formidable. None of those who have made statements to the contrary have ever had the experience nor do they possess knowledge of what the exact result would be.

It seems to me that we must at any rate advert to that sort of argument, and not merely brush it aside unconsidered.

I should now like to return, if I may, to the quotation made by the Minister, which I quoted, from the W.H.O. report about the Cameron survey. In making the point I want to make, I recognise that the intake there would be considerably more than what is proposed here. It said:

.... although tooth mottling and a low incidence of osteosclerosis were found.

That recognises that the tooth mottling and osteosclerosis were found in those places. Again, I do not feel that we should be satisfied merely to brush aside that sort of factual statement about certain results. Osteosclerosis is a disease of hardening of the bone. I do not want to make a false case, and, as I stated, the intake there is far more than is likely here, except, perhaps, when it would be cumulative over many years in adults.

Since osteosclerosis is apparently accepted rather lightheartedly, however, I should like to quote now from a thesis of a Danish scientist who is quoted by each of these reports. He is Dr. Kaj Roholm and, in 1937, he wrote a clinical-hygienic Study on Fluorine Intoxication. I should also like to say that he is, incidentally, quoted as an authority by the W.H.O. report and in the report of our own Consultative Council. I do not think this can be lightly brushed aside, either. He is dealing with workers who have been extracting cryolite and have suffered severe intoxication. This is what he says:

Among the most severe cases, four elderly men, there was practically complete rigidity of the entire spine and a more or less pronounced restriction of the head movements. This was particularly marked in a 57-year old male worker who had been employed at the factory for 12 years. The head was fixed in a bent-over position and turned as in torticollis; movement was possible only to an extent of 5-10º, in both saggital and frontal planes. In order to look sideways he had to turn the whole body. Simultaneously there was an increase of the normal dorsal kyphosis and asymmetry of the shoulder region. This man was unable to pick anything up from the floor by bending the knees and could not put on his socks without aid. In the four workers of this group there was a moderate but distinct atrophy of the long extensor muscles of the back.

Did they get it from drinking fluoridated water or from working in the mine?

They absorbed the fluorine from the dust in the mine. That report was quoted with approval by our own Consultative Council. They did not quote that extreme case. I am not suggesting that this is likely to happen if we fluoridate our water unless there is a cumulative effect. We are told that not all of the fluoride is excreted and what might be a nominal dose for a few years might become over a long number of years, quite a degree more serious, and this potential danger, cannot, therefore, be brushed aside.

I should like to look now into the question of distribution of this fluorine. It will be distributed through piped water. The point has been made by Senator O'Quigley that in a large section of rural Ireland, the children will not get it at all. I feel we would not be honest in claiming that we are dealing with this problem unless we recognise how many dwellings there are in this country which have no piped water. I intend to quote figures from the latest Statistical Abstract. The total number of dwellings in the Republic is 662,654 and of those, 255,244 have piped water. That means that more than half of our dwellings have not got it. That is the picture for the whole country.

The picture for Leinster is that out of 283,025 dwellings, 163,000 have a piped water supply; in Munster, out of 205,966 dwelings, only 70,900 have a piped water supply; in Connaught, out of 112,400 dwellings, only 14,000 have a piped water supply; and for the three counties of Ulster which are in the Republic, out of 61,263 dwellings, only 7,200 have a piped water supply.

I think it is fair to say that we must recognise now that, even with fluoridation of water in all cases, large sections of our people will not be reached at all by this new scheme. I say that in relation to the distribution of these valuable fluorides, and I now suggest that the method of distribution in these circumstances which are not even adverted to by our Consultative Council, the method of distribution through piped water, is grossly inadequate if we are really concerned with tackling caries in the children of this country, and not concerned only with city dwellers or mainly with Leinster. I am making the point in the absence of the Minister who has apparently been called for a division but I think it better to continue. I am sure that he will not mind missing what I have to say.

An Leas-Chathaoirleach

I am sure he will not.

The Senator is too modest.

A large proportion of our population, then, are not reached at all, and among those who are reached by piped water only those under 12 years of age will benefit. So I say that distribution of fluoride by this method is haphazard, slapdash and wasteful, because, as has been said in the Dáil, a large amount of the stuff will be used for washing cars or watering gardens, and not usefully, and many of our children will not be reached at all.

Now there are alternative methods of distribution as we see from the New York Commissioner. I should like to hear the Minister—and perhaps his technical advisers will note my query and prevail upon him to answer this question: What is his comment on the possibility of public health authorities distributing tablets? I should like to quote for his consideration the report of the Consultative Council, page 13, paragraph 33:

The use of fluoride tablets was also considered. No comprehensive studies have been carried out on the value of such tablets, but, assuming that adequate precautions are taken, we see no reason why they should not give satisfactory results.

I think that is very important and I do not think that there can be any suggestion that if you absorb it in tablet form rather than by drinking it in water, you are absorbing it in some less adequate way. In fairness, I must complete the paragraph:

The practical difficulties associated with their distribution and use are, however, of such a nature that their adoption for general use cannot be recommended.

They do not recommend the method, but see no reason why it should not be satisfactory, and I suggest that in the conditions obtaining in this country, where you cannot reach half the children through piped water, it would be far better to consider the distribution of fluorides in tablet form. It would have advantages which you are unable to get at present in that it could be controlled both in quantity and quality because it would be pharmaceutically made up, not merely an industrial byproduct. The amount absorbed by the children would be controlled and as it would not be distributed to old people or adults, there would be no danger of a cumulative effect in older people who might otherwise accumulate fluorides over a span of 30, 40 or 50 years. I suggest—I speak from no expert knowledge —that no expert can deny that there are certain attendant dangers from cumulative effects in making adults absorb fluorides over the whole span of their life. We do not know what cumulative effects there may be. We simply do not know, and none of our experts have tried to tell us.

It is also true of course that experts change their minds. Things that were not regarded as dangerous are coming to be recognised as dangerous, and expert opinion evolves. I think we all remember the time when in the shoe-shops of the city you could stand on a machine and have a look at your feet and see if they fitted the nails in the shoes. Now we are told that that is highly dangerous.

In support of my view that experts change their minds, I would quote from the report of our radio-activity consultative council which has just been laid on the Table of the House. They mention the fact that the British Medical Research Council changed their mind and have now come round to the United Nations Report view in which it was recognised that "the contribution of diagnostic radiology was estimated to be equal in the advanced countries to the normal background radiation". It says:

If those figures may be adapted to conditions in this country—and there is no reason why they should not be capable of such adaptation —it is quite clear that the greatest radiation hazard here is that derived form diagnostic radiology and secondarily from therapeutic radiology.

On that point experts 20 years ago said it was nonsense, fantastic. World expert opinion gradually changed. For a time, the British Medical Research Council differed, but now they have intimated that they had "reconsidered their earlier estimates and were disposed to agree with the United Nations Report".

I quote, again, from page 7:

The genetic effects of radiation are appreciable only in relation to the population as a whole and not to individuals. It is known that radiation induces mutations of genes and it is possible that many of the mutations which occur are caused by natural background radioactivity to which every one is exposed. It is not known what percentage of naturally-occurring mutations are actually caused by natural radiation. Ionising radiations have genetic consequences only in so far as they affect the reproductive cells or the cells ancestral to them in the reproductive organs (gonads). The frequency of gene mutation is increased by radiation and the rise in mutation rate is probably directly proportional to the amount of additional exposure to radiation. Any additional exposure, however small, must be expected to raise the mutation rate if only by a minute amount. Damage to genetic material is cumulative and irreparable.

I put the point that it is now recognised by experts that such damage is cumulative and irreparable. Could it be that the toxic effects of long-term absorption of fluorides might also be cumulative and irreparable?

In the report of our own Consultative Council, page 9, they quote Dr. Roholm and his work on fluoride poison from which I have already quoted, Fluorine Intoxication. They quote on page 9 what he says at page 179 of his book, and I might as well quote from the source. The point I am making is that they do not give the full quotation, and I know that the Minister for Health in particular is very averse to such a practice. They quoted from Dr. Roholm when he says at the end of Chapter 27 that “There is nothing to show that working with cryolite reduces the period of life or that cryolite workers acquire macroscopically recognisable organic lesions apart from the bone changes.”

They quote that for the purpose of implying that it cannot do you any harm, but they omit the sentences before that, where it turns out that this derived from an examination of only 15 people who died:

The examination of the deceased cryolite workers shows that a considerable number of them died of pulmonary tuberculosis and cancer in the gastro-intestinal tracts. Like the others, these diseases are among the generally occurring causes of death and the small material provides no basis for a discussion of the possible connection between working with cryolite and the cause of death.

And then follows the sentence quoted in our own Report. I think it is disturbing to find that our Consultative Council left out the first two sentences of Dr. Roholm's which say that there is nothing to show that it has fatal effects but that the case histories were too small to afford a basis for discussion. He does wind up, and this is significant: "apart from the bone changes", and I have quoted already what he means when he speaks of "bone changes".

My objections, therefore, to the present scheme would be that in dosing our population by the fluoridation of trapped water, in order to ensure that the optimal dose is got by all, some may well get too much. That is the first objection beyond any question to this legislation on the absorption of fluorides.

I should like to quote one last illustrative point on that. Our own Consultative Council made the point in Paragraph 26 that in a recent survey, "very mild mottling of the teeth" was produced in ten per cent. of the children by the amount suggested under this scheme, namely, one part per million. Ten per cent. were affected differently from 90 per cent. I quote that simply to show that the effect does vary, and I make the point that a varying effect will follow from something that can be dangerous itself, by a fluoridation scheme which will ensure that the optimal effects will be got by all, without being able to ensure that some will not get too much.

My second objection is that adults, for whom no benefit is claimed under this scheme, if they live in fluoridated areas, must absorb a fluoride regularly for 20, 30, 40 or 50 years in drinking the water, with no benefit to themselves but with some danger from cumulative effects.

My third objection is that very large numbers of our children in homes without tap water will not get this preventive treatment at all, under the scheme before us. No amount of talk about the dangers of caries and its incidence among children from such and such a place is relevant to the fact that they will not be getting treatment, if they happen in large numbers to live in areas where they will not be getting this water at all.

An Leas-Chathaoirleach

The Senator has made that point already in some detail.

I am summarising; I do not want to repeat. All I would say, in conclusion, is that arising out of these three major objections, it would be far better if we were to have a voluntary scheme based upon pharmaceutically prepared tablets which could be distributed free to parents throughout the Republic and not merely in the city areas, and distributed for children only. Coupled with that, and, I think, essential, is a long overdue wide extension of our school dental services. In other words, I accept the view that fluorides represent a valuable preventive for caries in teeth, but I am convinced that the best way of applying them is not by this hit or miss non-uniform, partial and very imperfect method here proposed, however attractive it might appear to be by its easiness and its cheapness. I am glad to see, for the Minister's sake, I finished just as he has returned.

Might I interrupt to ask if we could get an idea of how many more speakers there will be? We are anxious, if possible, to finish this Stage to-night.

An Leas-Chathaoirleach

It seems likely that we shall be able to finish this Stage to-night. There are only two more speakers, so far as I know, and the Minister will not be very long, I presume.

The efforts of Ministers for Health to combat dental decay must be commended, and I should be very loath to say anything that could be taken as voicing disapproval of their efforts and their researches into ways and means of ending this serious condition. I am not a trained scientist and my medical knowledge is very limited. For this reason, I have taken great pains to read anything I could obtain on the use of fluorine in the prevention of dental caries.

Many eminent persons trained in science, in medicine and in dental practice have made researches and reports on this subject. I am quite sure that all these people are sincerely anxious to do everything possible to end the menance to health which arises from decayed teeth in children; yet, while there is evidence claiming that the solution lies in providing a certain regular intake of fluorine, there is also as much evidence to the contrary, the latter evidence going so far, in some cases, as to claim that fluoridation of public water supplies, even at the low rate provided for in the Bill, will eventually have a bad effect on teeth.

Dr. George Heard, a doctor of dental surgery, of Hereford, Texas, a town noted for the excellence of its people's teeth, made researches over the years into that condition and he came to the conclusion that the relatively high content of fluorine—1.4 parts per million—was responsible for the excellent state of teeth in the area. As years went by, he observed that with dietary changes of the people from plain wholesome food to processed and fancy foods, tooth decay increased, in spite of the fact that they were drinking the same fluoridated water as hitherto. He later stated that he was now fully convinced that good natural food is the preventative of dental caries. He further said that while he believed that natural fluoride did, in a mild way, retard dental caries, he also believed the damage it does is far greater than any good it may appear to accomplish, in that it makes the teeth brittle and crumbly, so that when they do need attention, they can be treated only with difficulty, if at all.

This statement is confirmed by many experienced dentists. It has been claimed by those making researches into the subject of tooth decay that a 65 per cent. reduction in dental caries has been achieved by the simple expedient of having children brush their teeth with a neutral dentrifice after meals. On this point, I should like to express appreciation of the slogan now appearing on the stamp cancelling device which says: "Teach your children to clean their teeth." If children are given sufficient wholesome food and clean their teeth regularly, their teeth will take care of themselves and there will be no uneasiness with regard to side effects.

Passing the windows of the Permanent Exhibition of Irish Goods in St. Stephen's Green the other day, I stopped to admire a beautiful display of Dungarvan apples when I saw this notice over them: "In a recent large scale research by the Liverpool University School of Dental Surgery, it was found that eating a crisp juicy apple after meals is 90 per cent. effective for cleaning teeth as against 60 per cent. by using a toothbrush." That this pleasant method of preventing tooth decay in children is practical and can be put into operation is confirmed by a recent press report which recorded that the school health authorities in Widnes in Lancashire had arranged that an apple should be included in the school meals of the children in their health area.

We have all been shocked at one time or another by reports that, owing to a bumper apple crop, prices have fallen so low that it is not worth the growers' time to pick the fruit, which consequently has been left to rot in the orchards. Here is a great opportunity to avoid this waste by arranging for the supply of apples to schoolchildren and encouraging their parents to do likewise, and thus avoiding dental decay, and at the same time, to give an opportunity of building up fruit-growing into a thriving industry. It could indeed be found that here we could find the preventative of dental decay in children.

In my search for information as to whether the addition of fluorine to the public water supply was likely to prevent dental caries, I discussed the subject with a research worker who had studied the question over a period of years. He said the trouble was that fluorine and fluorides and their effects are quite unknown and unpredictable. His belief was that the relationship between the low incidence of dental caries in certain areas was not entirely related to the sodium fluoride in the water supply, but to the presence of other natural factors associated with the type of water.

Pressed on the question of the beneficial effects likely to follow the addition of fluorides to our water supply, I received the answer:

Somehow I cannot help feeling that this method of preventing tooth decay is like a person sitting naked on the point of a harbour in a winter storm, stuffing himself with aspirin and sulpha tablets to cure his cold.

Internationally-known medical men have pointed out that even the most ardent advocates of fluoridation admit that it can be effective only until dentition is complete, at 12 to 15 years. Beyond these ages, fluoridation can do no good whatever. It seems undesirable, therefore, to add a substance to water which will benefit only about 25 per cent. of the population and might be harmful to the other 75 per cent.

Much of the food we consume contains fluoride. Some people drink more water than others and will, therefore, consume more fluoride. In the British Dental Journal, Volume 103, Number 8, Dr. C.G. Dobbs, Senior Lecturer in University College of North Wales, in an article entitled The Safety of Fluorides in Water says:-

There is no level of intake at which fluoride changes from a toxic to a purely beneficial substance and since it is the total intake that matters, the question at issue is not the safety of fluorides at one p.p.m. but the safety of any permanent addition to the general intake of the fluoride, especially by those whose intake is already high.

The dilution proposed in the Bill is very low but one cannot entirely overlook the warning of an expert. It is known that some people are sensitive to certain drugs and other substances. There is more than a possibility that many people may suffer ill-effects from the constant use of fluoridated water. In this country, there is a very high incidence of rheumatism and allied complaints among our people. Fluoride, as has been said, is a cumulative poison and, as such, is stored in the human frame, particularly in the bones and I think there is evidence that the substance is capable of aggravating rheumatism and similar complaints and causing greater suffering to those unfortunate enough to be afflicted with them. These people can obtain no benefit from the fluoridation of water. They can only run the risk of having their pains increased in a disease for which the medical profession admits they can do very little. Has the Minister considered this aspect of the fluoridation of water?

No one would want to halt the Minister in his pursuit of means to prevent dental caries and the ill-health which can arise therefrom, but the question is: is this the right way to administer the substance which he believes holds the solution? Making the fluoride available in tablet form to those desiring and requiring it and the education of children in dental hygiene seem better ways. The Fluorine Consultative Council referred to the use of fluoride tablets and could see no reason why they should not give satisfactory results, though they did refer to "practical difficulties associated with their distribution and use."

I should like the Minister to give his views on the distribution of fluoride in tablet form. There are, unfortunately, as already mentioned, many areas in the country where there is no piped water supply. I am sure, if the Minister is fully convinced of the value of fluoridation in the elimination of dental caries, his Department will have to make some arrangement whereby fluoride is made available to the children in these areas. There does not seem to be any way to do this except by making the fluoride available in tablet form.

If he does so and if he is able to get over the "practical difficulties associated with their distribution and use," would be consider withdrawing his Bill to fluoridate the water supplies, and make fluoride tablets available, free of charge, to all those who wish to have the substance available for their children? This would allay the uneasiness of the large number of people who are not convinced of the benefits claimed for fluoridation of the water supplies and who fear that this interference with water supplies by the addition of a toxic substance will have serious effects on the health of themselves and their children.

I want to make only one brief point on subsection 6 of Section 2. The Minister has gone a long way towards meeting any objection that it might be a little unconstitutional to bring in such a Bill as this. I should like to ask him to examine the position again to see if he has not gone too far in this subsection. I feel that he has left the way open, bluntly speaking, for a crank to stop the Minister having an examination of a whole school under this section.

There might be some reason for such a person stopping the examination before the local water was fluoridated, but after that has been done, could a manager of a school, under this section, stop the pupils being examined? That is the point that is worrying me. Could even a headmaster of a school stop a re-examination after the water had been used for a year or two years? I feel that the Minister has gone a little too far in providing this constitutional safeguard. I should like to hear the Minister on this point.

At the outset, I must say that one of the main objections I had to this Bill was in relation to the question whether it should be merely permissive or whether the Minister should have power to direct the local health authority to comply with it. The Minister, in his very lucid introduction, set my mind completely at ease on that. If we are to have this done, then it is better that it should be done in the way the Minister has approached it, on the basis of research and a close study of the problem. The Minister indicated in the Dáil that this is being done in conjunction with the Medical Research Council so that I think the Minister has taken all proper steps in that respect.

I think he would be well advised to hasten very slowly in this case. Senator Sheehy Skeffington has done a great service to-night by putting on record a very reasoned and very detailed case showing that the matter is not all cut and dried, that it is not quite so well decided as the Minister would have us believe from his opening speech. There are many very eminent and responsible authorities who hold against this. Apparently they are in a minority. Still, when that minority has amongst it such a distinguished person as Commissioner Ford of New York, we must pay quite an amount of attention to it. I do not intend to weary the House with quotations. They have already been given by Senator Sheehy Skeffington and are on record. It urges upon us a policy of extreme caution. I hope the Minister will adopt that approach in putting this into effect. In other words, go slowly—deal with only one or a few districts at a time and study the local effects very carefully. More important still, those carrying out the research, the Medical Research Council and the officials of the Minister's service, will have constant reports coming in from other parts of the world as to how it is progressing, whether anything unexpected has been happening.

We must realise that 20 or 30 years is a very short span. Effects may take a long while to manifest themselves. Most of the experimental evidence is based on regions where there are natural fluorides in the water. There may be a difference between natural fluorides in the water and the artificial injection of fluorides into a water system. I would feel very anxious in the years ahead to know what are the reports coming back from those regions that have been subjected to the artificial injection of fluorides.

A policy of hasten slowly is essential. Go back a few years and recall something quite dramatic. We might take the appearance of cortisone on the medical scene and the great relief it gave for rheumatism, for example. We find that a couple of years afterwards there were side effects that led to the discontinuance of that treatment. I do not wish to stress this too far. The Minister has taken a very wise step in being so fully associated with the Medical Research Council in this matter. He and his Department will show their wisdom by the reliance they place on the Medical Research Council in the years ahead.

One of the big problems is the fact that so much of the country is without piped water supplies. It seems a very crude and inefficient system that in order to get fluorides to children under 12 years of age who will benefit from the treatment, the whole water supply must be medicated. It is held that not more than one or two gallons in every thousand are used for human consumption. Of that, children consume no more than one-sixth or one-seventh. Therefore, you are really using only about one gallon in every 5,000 to 10,000 that are treated. That seems very wasteful. Added to that is the fact that we know quite definitely it has no beneficial effect on grown-up persons. It may even have a bad effect but at least it is of no use to them.

Even if it cost a little more it would be a safer approach if some other means could be used to give fluorides to the children. It occurs to me that there should be no great difficulty in fluoridating the supplies to the various schools throughout the country. A small plant, inserted in the entry water pipe and suitably designed, should ensure that the school supplies were treated. If that were done, I feel far more children would be reached than can be reached by the present method. There must be a running water supply in at least 70 or 80 per cent. of our schools at present. We should aim at a target of 100 per cent. as soon as possible.

The case has been made that, if that is not quite feasible, perhaps a tablet form is possible. A quotation was given by Senator Sheehy Skeffington showing that this is actually in operation in New York city so we can see it is practicable, even if it costs a little more, which I doubt when you take account of the great waste of water encountered in the mass injection system.

On the question of teeth care and the lack of dentists in the country it might be mentioned that we have only 700 or 900 dentists. I hope the Minister will now make a serious effort to increase the number of dentists within the country. If, as he says, £30,000 a year is a small cost to pay for fluoridation, no doubt he will regard an additional £30,000 a year as a very small contribution towards increasing the number of our practising dentists in the country.

Speaking for our Dental School in University College, Cork, we are simply tied to an output of 12 to 14 students per annum because the facilities provided for the practical training of these students are inadequate. That can be remedied quite easily. I believe the cost is only about another £30,000 to provide the necessary extension to the Dental Hospital. I hope that will commend itself to the Minister. If it does, it will be a positive means of bringing better dental care to those 50 per cent. of our children who are not likely to be reached by the present approach.

I confidently appeal to the Minister, while he is in this generous financial mood, to give serious consideration to my suggestion. Also, the capital cost involved in the present scheme for fluoridation is estimated at £100,000. If we had £100,000, we could do a mighty lot in our dental schools in Cork.

Ní choimeádfaidh mé an Seanad ró dhéanach. Tá ár n-aire go léir dírithe ar uisce, uisce le n-ól, agus táimid ag moladh sa Bhille seo agus sna cumhachtaí atá ann fluairíd a chur san uisce. Is í an cheist atá i m'aigne ná cé mhéid daoine atá ann ar chor ar bith a ólann uisce fuar? Táimid ag caint mar gheall ar leanaí agus ar an ngá atá ann go n-ólfaidís uisce den sórt sin. Ach de réir mo chuid eolais agus mo chuimhne —agus is cuimhine i bhfad siarí—is beag uisce a d'ólaimis. D'ólaimis bainne agus nuair ná raibh an bainne ann le n-ól d'ólaimis tae.

Is beag de sin a bhíodh agam. Pé scéal é, is beag duine a ólann uisce as an bpíopa. Is gá dúinn ár n-aire a dhíriú ar an rud sin. Tá mé ar thaobh an Bhille. Tá mé ar thaobh aon rud a dhéanfaidh aon leigheas nó maitheas d'fhiacla lofa páistí na tíre agus an dream óg atá ag fás aníos chugainn anois. Buíochas le Dia, tá mo chuid fiacla féin i mo bhéal agam fós agus ní raibh sé riamh rómham fiacla a cheannach.

An bhfuilimid ag díriú an iomarca aire ar uisce amháin? An bhfuil nithe eile ann go bhfuil an t-easnamh céanna orthu mar bhia, arán, feoil agus nithe eile mar sin? Sílim go bhfuil easnamh den rud céanna orthu.

Tá ní eile a tháinig i m'aigne ar an gceist. Is ar na leanaí ná fuil ar an saol fós nó ar phaistí dó, trí nó ceathair de bhlianta d'aois a rachaidh an Bille seo i bhfeidhm má théann sé i bhfeidhm. An bhfuil aon tuairim ag an Aire faoin tréimhse a chaithfear sar a mbeidh aon toradh le fáil againn ar an triail seo? Sílim go mbeadh sí fada agus gur fada uainn í agus nach bhfeicfidh cuid againn í ar chor ar bith. Sin í an cheist. An mbeadh an gléas sin ró-mhall chun aon leigheas a bheith aige ar an ngalar sin ar dhaoine óga anois agus ins na blianta le teacht.

Is cuimhin linn go léir na cíora breátha fiacla a bhí go deireadh a saol ag an gcuid is mó dena daoine aosta. Níor ghá a gcuid fiacla a bhaint amach ach amháin i gcás tionóisce. Cén fá go raibh na fiacla go breágh acu agus nach bhfuil siad anois ag a sliocht? D'ólaimís uisce as toibreacha agus is as na toibreacha céanna atá na daoine ag ól ó shoin. Mar sin, ní raibh aon easnamh ar an uisce. Sin í an cheist atá im aigne. Fé mar a deiridís sna seanlaetheanta, nuair a bhí fiacla lofa ag na daoine óga cuireadh an milleán ar an tae, ar an bplúr bán agus mar sin. Is dócha nach raibh an ceart ar fad ag na daoine an uair sin nuair a cuireadh an milleán ar na rudaí sin, ach sin mar a bhí an scéal acu. Bhí tuairim chinnte go leor acu ar an meath a bhí ag teacht ar an gcarbad agus ar an ngléas coganta a bhí acu. Ba mhaith an rud é, ach ceist an uisce a réiteach, leigheas d'fháil ar an ngalar atáimid ag cáineadh. Rinne mé tagairt don nós a bhíodh againn bainne agus tae a ól. Óltar deochanna eile in Éirinn seachas bainne agus tae. Óltar Guinness, lager, líomanáid agus mar sin.

Ní bhaineann an Bille ach le huisce.

Tá a fhios sin agam ach uisce a bhíonn iontu sin. An gcaithfear an stuif a chur ins an uisce sin?

Tá a lán ceisteanna den cineál sin ann agus má tá fonn orainn fiacla a leigheas, caithfear tosnú ar an scéal ó bhun. Is dóigh liomsa go bhfuil ceisteanna ann nach bhfuil réitithe againn fós. Arís, tá me ar thaobh an Bhille mar is iarracht í ar leigheas a fháil ar an tubaist atá tár éis teacht ar an bpobal.

In his remarks on the Bill Senator Burke raised a question with which I think I should deal now and I would hope that I shall be able to reassure him completely as to the effect on industry of fluoridating water. In 1952, the British Ministry of Health sent a mission to study the fluoridation of domestic water supplies in North America as a means of controlling dental caries. Among the points which are dealt with in their report is the effect on industrial processes of fluoridating public water supplies and this is what the United Kingdom mission reported in regard to that matter. They said under the heading "Effects on Industry":

Fluorides in water, at a level of 1.0 p.p.m. do not give a taste or odour and in spite of persistent questioning we have been unable to learn of an effect on any industry, including bottling, brewing, baking, laundering and chemical manufacture.

Now, that is the report of a mission which was sent by the Minister of Health for the United Kingdom to ascertain the effects. It was not a mission which was in any way involved in a controversy about the fluoridation of water. It was sent out to investigate on a purely scientific basis the effects of the process.

The American Dental Association in November, 1956, dealing with the assertion that fluoridation may interfere with food processing said this:-

In the early years of controlled fluoridation there was some hesitancy on the part of food and beverage processors about possible bad effects on their products from changes in the water supply. The weight of evidence now available from the experience of these industries in areas where the water contains fluorides, either as an incidental occurrence or in controlled amounts shows that there is no harmful effect from fluorides present in the water supplies in concentrations recommended for dental health.

The American Institute of Baking conducted a study in 1950 and reported, "The addition of fluoride ion in concentrations up to 10 parts per million in the sponge and dough water has no effect upon bread quality. Bakers in communities that plan to incorporate fluorine in the city water supplies as part of a program to reduce the incidence of dental caries should anticipate no difficulty in using such water for bread productions."

It is reported that Green Bay and Kaukauna, Wisconsin, have some of the largest cheese plants in the world. Green Bay's water supply contains 2.5 p.p.m. fluorine and Kaukauna's water has 1.8 p.p.m. fluorine.

It is also reported that Milwaukee breweries used deep well water containing as high as 1.8 p.p.m. fluorine before the city began to use lake water. The following cities in Wisconsin have brewing industries and use water containing fluorides either in controlled amounts of about 1 p.p.m. or incidentally occurring at 2 and 3 p.p.m.: Rhinelander, Beaver Dam, Sheboygan, Columbus, Madison, Oshkosh, Green Bay, De Pere and Allonez.

The report of the New Zealand Commission on Fluoridation has this to say:

Very little evidence was made available to us in regard to the possible effects of fluoridation on industry, but Dr. Eva Hill produced as an exhibit a copy of an address delivered by her in Hastings on 8 November, 1955, in which she stated:

I will briefly refer to possible detrimental effects on industry. Cordial manufacturers will be faced with a dilemna, the fluoride interfering with their processing. Canning factories and freezing works in the district, even if not using your water supply, will be under suspicion throughout the country, and sales may fall in consequence.

The Commission commented on Dr. Eva Hill's statement in these terms:

In regard to this statement we think it is significant that no representative of industry appeared before us to support the views of Dr. Hill. This is particularly relevant so far as Hastings is concerned since that town has now had a fluoridated supply for some years.

Our own Fluorine Consultative Council, in its report, says:

No adverse effects on industrial, agricultural, horticultural or other similar processes due to the use of fluoridated water have been substantiated.

I think that should dispose of any fears which may be entertained by Senator Burke or any other persons as to the effect on industry of the fluoridation process. With regard to our great industry in this city, I may say I have received no representations from Messrs. Arthur Guinness that this process is likely to be in any way harmful to their products.

Senator O'Quigley asked what provision we were making for dealing with the rural population. Naturally, that is a matter to which I have given a great deal of consideration and it is not one to which I can find a very ready solution. One way in which we could do it would be to extend piped water supplies much more widely in the rural areas. If I had had my way this would now be well under way. In 1947, I had set up a commission to consider the whole question of the extension of piped water supplies to the rural areas but unfortunately the Coalition Minister for Local Government who succeeded me in that Department scrapped that commission. We are now perhaps 10 years behind the times. I know my colleague, the Minister for Local Government, has the matter again under investigation. We hope that in due course we will extend piped water supplies as widely as we have extended electricity supplies to the rural areas.

We are not, however, merely relying upon something which may happen in a few years from now. At the moment, the position is that there is intensive propaganda going on in most schools in the country through schools medical inspections, lectures in the schools, school film shows, and so on, to make the children alive to the fact that their teeth are precious and worth preserving. In addition, we are doing our utmost to increase the dental personnel in the country.

The Minister for Education and I have recently joined in an effort to provide funds for the building of a new dental hospital in the city of Dublin. That is a matter which has been under agitation for a very great number of years but it remained to us—and I think I am entitled to claim credit for the Minister for Education and myself for the fact that we have at last succeeded in removing the obstacles which prevented the building of a dental hospital—to make provision for a dental hospital in the city of Dublin adequate to meet the demands of those who are anxious to become members of the dental profession.

The position in which we find ourselves in that regard in this country is very much due to the fact that it was quite impossible—I withdraw the words "quite impossible" and say that for many years past and even to-day the accommodation for dental students in the city of Dublin is very restricted. It is even more restricted in Cork. But the particular problem there had not to wait for my attention until Senator O'Quigley raised the matter here to-night. I can say that simultaneously with the decision to make provision for a new dental hospital and teaching hospital in the city of Dublin, I asked the committee in charge of the dental hospital in the city of Cork to submit proposals to me for an extension of their hospital. We are taking what I think are unusual steps to ensure that the dental school in Cork will have an opportunity to develop even more successfully than it has done up to the present.

Senator Sheehy Skeffington expressed disappointment with the results of the effects of fluorine on general health, as evidenced by the study of the effects of fluoridation of the water supplies in the twin towns, Bartlett and Cameron. He was surprised that the morbidity and mortality in those two towns was more or less the same. I am not holding out fluoride as a sort of cure-all. I have never said it will prolong life. I merely said it will make teeth less susceptible to dental decay and if people have good sound teeth, they are likely to enjoy good health. A man may live for quite a while in bad health. It will not be a very happy existence, but if he has good teeth, he he is more likely to enjoy good health and have a happier life. As I say, I am not saying that fluoride is a cure-all. I merely say it seems to be an essential constituent for the development of good sound teeth——

——and that if there is an adequate in-take of fluoride, the teeth of the children are likely to be much less susceptible to dental caries.

I agree, and general health will be better.

I hope so. I am not a prophet but that is my anticipation. The Senator also had a great deal to say about the famous Mr. Ford—not Henry, because Henry, after all, did stick to the business which he knew best. But Mr. Commissioner Ford seems, in my view, to go far outside his territory.

On a point of order, Henry did not always stick to it. He sent out a peace ship. He had many vagaries and had as many foolish things to do as most people.

He did that in his lighter moments.

He had a lot of lighter moments.

I was speaking about Mr. Ford of New York, of the water supply system of New York, and as a supplier of water, I am sure he does as good business as any water supplier in the world. But health and particularly dental health is not really his province, and while the waterworks of New York have rejected fluoridation—while the city of New York, I should rather put it, has not yet adopted fluoridation due to the opposition of the water supply department— the New York board of health, which, I think, are more concerned about the general health of the public and are more likely to speak with the greater authority, recommended fluoridation in 1952 and on the basis of exhaustive study, they reaffirmed their endorsement of fluoridation in 1956 as a much needed public health procedure. If I wanted to know what I should do in order to preserve my teeth in a sound condition I would go to a dentist and if I was going to avoid certain ills, I would go to a physician rather than to a mineral water manufacturer to advise me on both these things.

You might find a poet making a good Minister for Health.

He has long ceased to be a poet. Dr. Stralfors, who reported adversely on fluoridation in Sweden, had a great deal to say about the inadequancy of the study which had been made in America and elsewhere and was very caustic—that would not be an overstatment on what he had to say—particularly about Bartlett and Cameron. His remarks about his scientific colleagues elsewhere, however, were mild indeed by comparison with what the majority of the members who signed this report had to say about Stralfors. That is why I asked the Senator to read what they had to say about him. They said this:

On February 21, 1958, Drs. Sellman and Ericsson submitted to the Royal Medical Board an addendum to the report, in which these authors comment upon some of Dr. Stralfors' statements in Chapter IV of the main report.

The authors supply more exact data from many of the articles quoted by Strälfors.

Therefore, they find him guilty of suppression.

These data demonstrate that Strälfors' criticism of investigations supporting the safety and caries preventive effect of water fluoridation is exaggerated, while on the other hand a notable lack of criticism appears in his quotations of papers produced against the fluoridation of drinking water. Some of Strälfors' statements are found to be purely speculative.

If I were looking for an authority to support me in a case against fluoridation, I should like to have a more reliable one than Dr. Strälfors to rely upon.

The question of using some alternative method to fluoridation to prevent dental caries was raised both by Senator Dr. Sheehy Skeffington and, I think, by Senator Miss Davidson and some other Senator. I think Senator Sheehy Skeffington stressed fairly strongly that Mr. Commissioner Ford had suggested that tablets might be used as an alternative. This is what the Expert Committee of the World Health Organisation has to say about tablets.

I shall just put it on record again and I shall quote the paragraph in full:

At present, the value of milk and salt for fluoride administration cannot be compared with that of drinking water, since the evidence in favour of the first two vehicles is incomplete; in particular there is a total lack of clinical evidence of their effectiveness. On the other hand, tablets have been shown to have some positive effect although the experiments with tablets have been performed for a much shorter time and on a much smaller scale than drinking water fluoridation.

Continued research on these fluoridation methods should be encouraged. If their effectiveness, practicability, and safety of application can be satisfactorily demonstrated, they may become very valuable in regions where water fluoridation is impossible.

It is quite clear from this that the whole thing is in a highly experimental state and that we cannot wait, having regard to the extent which the dental survey showed of the prevalence of caries in this country.

For rural areas, we are waiting.

That is as may be. Are we to deprive a large part of the community of the benefits of this process simply because we cannot give it to everybody else?

You can give it in tablet form.

We are satisfied, says the New Zealand report, that there are weighty objections to the use of fluoride tablets. These are:—

(i) There are no published studies on the use of tablets containing fluorides.

(ii) The obvious difficulty with this method is that it is necessary for the parent to administer fluoride to each child each day and every day for the first 8 to 12 years of the child's life.

(iii) The studies establishing the effectiveness of fluoride show that if the full protective effect of the fluoride is to be obtained the daily fluoride ration must be consumed in liquid form on a number of occasions. This adds substantially to a mother's domestic activities.

(iv) While in individual instances the use of tablets may prove a feasible method, generally for families containing more than one child, it tends to be troublesome and spasmodic in application.

(v) It is suggested that if these tablets are used the majority of people will cease using them in adolescence and any subsequent benefit arising from the topical effect of a fluoride on the teeth would be lost.

Our own Consultative Council says this:

The use of fluoride tablets was also considered. No comprehensive studies have been carried out on the value of such tablets, but assuming that adequate precautions are taken——

——"there is no reason why"—until they have been tried and then we do not know what the results may be. We are told there are grave dangers in taking an overdose of fluorides and the Senator did dilate at great length on that. He made my flesh creep when he was dealing with the symptoms and conditions of the unfortunate four miners who were working in an atmosphere impregnated with fluoride. It made me feel that after all we should be very careful——

——not to make any provisions that have not been thoroughly tested and thoroughly proved. However, to get back to the report of the Consultative Council. I was saying that there was no reason why they should not give satisfactory results.

The practical difficulties associated with their distribution and use are, however, of such a nature that their adoption for general use cannot be recommended.

I read that paragraph to the Seanad.

I did not know that. However, I am just reading it again. I must say we had a very interesting reading this evening from Senator Sheehy Skeffington and I just want to enforce upon the memory of Senators the things which he—in all fairness—properly quoted. Having heard them two or three times, they will be the more firmly fixed in their memory and they will understand, taking everything into consideration, that there is not at the moment any practicable and safe way of providing the necessary intake of fluorine to ensure, so far as it can be ensured, that the teeth of our children will be less susceptible to attacks of this disease than they are to-day.

Question put and agreed to.

I think there is general agreement on this Bill and we might have the remaining Stages now.

After Christmas, a Chathaoirligh. There will be a number of amendments and we want to have many points made by the Minister considered adequately.

I did not hear any suggestion in regard to amendments tonight. I think this is only window-dressing.

It is not window-dressing.

I should like to support Senator Burke. I think such undue haste is very wrong. We spend little time enough here.

Could we take the next Stage tomorrow or next week? Would that be satisfactory?

It seems hardly fair. We have agreed to sit until twenty minutes to 11 and we have done well by the Minister. I do not think he would ask to have the next Stage tomorrow. Whether we reassemble next week is a matter for the Seanad to decide.

The next sitting day after tomorrow?

Very well.

Committee Stage ordered for next sitting day after Thursday, 15th December.
The Seanad adjourned at 10.45 p.m. until 3 p.m. on Thursday, 15th December, 1960.