MASS MEDICATION

HL Deb 27 January 1954 vol 185 cc488-522

2.56 p.m.

LORD DOUGLAS OF BARLOCH rose to draw attention to the infringement of the liberty of the subject, and the danger to the health of individuals, inherent in projects of mass medication, such as the addition of chalk to flour, iodine to salt and fluorine to public water supplies; and to move for Papers. The noble Lord said: My Lords, the battle for the liberty of the subject has to be renewed and fought in every age. No sooner has one encroachment been swept away than I another arises to take its place. The passion to regulate the lives of others is deep-seated and hard to root out. It is most dangerous and most insidious when it arises not from motives of personal gain but from the desire to inflict benefit upon others. In this era, the greatest danger to human freedom is the specialist or the expert, the man who has soaked himself deep in some branch of research and who wishes to impose upon others the pattern of conduct which he thinks is best. I do not refer to scientists, for a true scientist is one who has learned to take a broad and balanced view, one who is imbued with a healthy spirit of scepticism and not with fanaticism.

This Motion was originally placed upon the Order Paper at the end of July. The immediate occasion of it was an announcement in The Times newspaper, which appeared to be officially inspired, that the Ministry of Food intended to make an order within a few weeks time requiring chalk to be added to whole-meal bread. If that had been done, it would have become impossible in this country to buy any bread to which chalk had not been added. I thought, and a number of my noble friends with whom I discussed this matter also thought, that this would be an outrageous interference with the liberty of the subject, and so I put down this Motion. Happily, that particular danger has receded. The Minister of Food has exempted "true wholemeal flour" from the requirement t that chalk be added to it. There is thus left a loophole through which those who do not want their flour tampered with can escape. It is not a very large loophole, because bread made from true wholemeal flour is not easy to find, and it is dearer than bread made from "National" flour, one reason for this, of course, being that the Minister of Food subsidises the price of "National" bread.

We have thus reached the position in which, by Government order, the vast: majority of the population are obliged to have chalk in their bread. The total amount of chalk which is used for this purpose in the course of a year is about 11,000 tons. In passing, I may remark that chalk is cheaper than flour, and as the mixture is sold at the price of flour, the millers have nothing to complain of. One is reminded of Tennyson's line: And chalk and alum and plaster are sold to the poor for bread. The theory which underlies the addition of chalk to flour is that the population are not getting enough calcium in their diet—not enough for good health, it is said. For the purposes of this argument I am going to assume that there are a number of people who are not getting sufficient calcium, although many common foods, such as milk, cheese, yolk of egg, peas, beans, treacle and green vegetables, are good sources of it—and, of course, the water supply of London and of some other places also contains a considerable content of calcium. Even if it be true that some people are not getting enough calcium in their diet, are we entitled to force them to eat more of it by putting chalk in their bread? That is the fundamental issue of principle which is raised in my Motion. Another matter to which I must draw attention, and which is characteristic of all forms of mass medication, is that this procedure offends against the basic code of medical practice. The dose is administered without any examination of the patient, without regard to age or sex, without regard to physical condition, irrespective of whether it is required or not. In this respect, also, the procedure is obnoxious and immoral.

Let me now turn to another example, the proposal to add iodine to salt. This matter received considerable attention in the Report of the Chief Medical Officer of Health for the year 1950. A Committee of the Medical Research Council had reported in 1944 that endemic goitre was on the increase and that this was probably due to reduced consumption of sea fish, which is rich in iodine. As these researches were conducted during the war, it would not have been entirely surprising to note that the consumption of fish had declined. A later Report, in 1948, long after the war was over, recommended that all salt should be iodised by adding ten parts per million of potassium iodide. In 1950, the Food Standards Committee of the Ministry of Food recommended that an order should be made requiring that all free-running salts should, within a year, have, not ten parts but from fifteen to twenty parts per million of potassium iodide added, and that within a further two years all other salt should be treated in the same fashion. If recommendation had been carried out, it would have become impossible for the consumer to buy salt which had not been iodised.

This proposal evidently occasioned some anxiety, for the Report of the Chief Medical Officer makes it clear that some people made representations that the incidence of goitre had been exaggerated. Others drew attention to the fact that some persons are hyper-sensitive to iodine, but this objection was brushed aside on the ground that the objectors had not supported their case by statistics. I pause here to draw attention to the fact that it hardly ever lies in the power of the non-official public to produce statistics on such matters, and if this is to be a sine qua non, we shall all soon be at the uncontrolled mercy of the experts. The final upshot of it was that the Medical Research Council recommended that non-iodised salt should be available wherever this was considered necessary on medical grounds—in other words, we should all have been obliged to obtain a doctor's prescription in order to be able to purchase unmedicated common salt.

So far, we have the matter as it was explained in the Report of the Chief Medical Officer for the year 1950. In the following year, the subject received only three lines, to the effect that unforeseen difficulties were being encountered in providing suitable packaging material, What these difficulties were, is not explained. In the Report for 1952, the last one issued, I could find no mention whatever of iodised salt. The last reference I have seen to it was an Answer by the Minister of Food on July 21, 1952, in which he said that there were a good many objections of a technical nature, some of which were quite serious. So it looks as if this plan, which was introduced with such a flourish of trumpets, is on its way out. The strange thing is that it was ever proposed. Even if it were true that goitre was prevalent in certain districts owing to lack of iodine, why should people in other districts be compelled to partake of it when they do not need it?

Here again, the fundamental objections to compulsory mass medication spring to light. The intake of iodine is obviously extremely variable, as sea foods are one of the principal sources of it. Iodine is a very potent and active chemical it is quite immoral to force it upon everyone without regard to the amount that he is already having without regard to physical condition or any other circumstance which a doctor would consider in dealing with an individual patient. This is a negation of the art of medicine as hitherto practiced; it is also the negation of the liberty of the subject. Before I turn to the other example mentioned in my Motion, I should like to say that the noble Lord, Lord Methuen, informed me that, had it been possible, he would have been here to support me this afternoon. He desired particularly to refer to the chlorination of water supplies, which he considers has been carried to excessive lengths in recent times, leaving residues in public water supplies which may have physiological effects. This is a view which, I understand, will be supported particularly by adherents of the homeopathic school of medicine, of whom there are a considerable number in this country.

I now come to the latest example of mass medication—the addition of fluorides to water supplies. It is well known that fluorides are deadly poisons. On this account, sodium fluoride is largely used as a rat poison. At one time fluorides were used as preservatives in foods, but the use in foods is now prohibited by law. The addition of fluorides to the public water supplies must, therefore, be a matter of grave concern. This practice has been developed within the last few years in the United States, where there has been an intensive campaign to persuade local authorities to adopt it. The ground upon which it is advocated is that if a small quantity of fluoride is given to children regularly during the period of growth and tooth development, the teeth will be made resistant to decay. It was already well known that if larger quantities of fluoride, such as are found occasionally in naturally occurring waters, are taken in, the teeth are severely affected and show visible blemishes. It is now stated that if fluoride to the extent of one part per million is added to the water supply the teeth of children will become resistant to decay, but that no bodily ill-effects will follow. I would mention that the advocates of this proposal say that the proportion should be one part per million of fluorine, and they admit that it is not wise to go much beyond that.

During last year a Mission was sent from this country by the Ministers of Health and Housing to the United States to investigate what was known there. They reported—and their Report has been published—that fluoridation of water supplies was a means of reducing the incidence of dental decay, and they recommended that in this country: it would be advisable in the first instance to add fluoride to the water supplies of some selected communities. On December 3, the Minister of Heal the stated that the Government had accepted the recommendations of the Mission, Some towns, therefore, must look forward to the prospect of having fluorides added to their water supplies in order that an experiment may be carried out upon the whole of their citizens.

For the purpose of my argument I am going to assume that it is a fact that if children imbibe waters so fluoridated during the growing period their teeth will—for a time at least—be less liable to decay; it may be, of course, that the effect is not permanent. The first question that arises is: How does this happen? That question the Mission have been unable to answer. They say that this matter has not yet been elucidated, and they give no fewer than four different and inconsistent theories to explain it one thing, however, is clear, and that is that fluorine reacts with something in the teeth and, consequently, changes the nature of the teeth. If higher concentrations of fluoride are imbibed, the change becomes greater, and blemishes upon the teeth become visible. There is little doubt that the fluorine unites with the calcium in the teeth: scientific evidence of this is available. This leads to a very important question. The advocates of fluoridation admit that it can prevent dental decay only if it is administered to children. Their procedure, however, involves that it is administered to every member of the community for the whole of his life. What happens to the fluorine which is imbibed by adults? The teeth are not the only part of the body containing calcium: it is found in the bones, and elsewhere. If the teeth are no longer capable of combining with fluorine, will not fluorine combine with calcium elsewhere in the body?

An attempt has been made in the United States to answer this question by comparison of the vital statistics of areas having naturally a water supply containing about one part per million of fluorine with others having much smaller amounts. Anyone who is familiar with statistical investigation must know that such comparisons are worthless, and the Mission very candidly state: While many Americans live in areas where the natural fluoride content of water is about one part per million or more it is extremely difficult to make a comprehensive analysis of mortality statistics, on the basis of previous exposure to fluorites, and no such analysis has been attempted. Hence, I suppose, the recommendation to make a mass experiment, willy-nilly, upon some city or town in this country. An incidental but highly significant point in. the Mission's Report is the statement—and this has also been said by advocates of fluoridation in the United States—that it makes no difference what kind of fluoride is used to fluoridate the water supply. That statement appears on page 12 of the Mission's Report. But, strange to say, in one of the appendices, on page 65, they say: It has been reported that stannous fluoride is more effective than either sodium fluoride or sodium silicofluoride in preventing dental caries. Is this a new scientific discovery, that it makes no difference to the human body whether it is treated with salts of sodium or salts of tin, or is this just a typical example of the slipshod way in which this subject has been treated?

That leads me to say something about the methods which have been used in the United States to push the fluoridation of water supplies and which, I am afraid, are beginning to be used in this country. The plan was originated and has been strongly advocated by dentists in the American public health services. Of course, all dentists are not advocates of it, and in this country Mr. Charles Dillon has contributed some significant criticisms in his articles in the Dental Practitioner, pointing out the general dangers to health and also the possibility that if fluorides do delay dental decay in earlier years of life, they may actually aggravate it in the later years. By and large, however, fluoridation has made headway by the specialist argument that it reduces dental decay, without regard to any other aspects of the matter. In the United States it has been put over by methods which in any other connection would be described as "high-pressure salesmanship." I do not suggest that the dentists who have advocated it have any commercial interest but, in passing, I may note that there are commercial interests who would like to see it done. Fluorides are highly toxic chemicals which are by products of certain industrial processes, and they are, both literally and metaphorically, a drug on the market. Of course, the manufacture of machinery for putting them into the water supply would be a gain to those who manufacture this type of machine.

It is apparent that the experts who have advocated fluoridation have paid scant attention to the physiologists and pathologists who have drawn attention to the possible hazards to general health. I am going to quote one example of this from the proceedings of the annual conference of State Dental Directors, which was held in Washington, D.C., on June 6 to June 8, 1951. This quotation is from the speech of the Dental Director of Wisconsin. Referring to another speaker who had mentioned some possible difficulties, he said: I noticed that Dr. Bain used the term adding sodium fluoride: We never do that; that is rat poison. You add fluorides. Never mind that sodium fluoride business. All of these things give the opposition something to pick at, and they have got enough to pick at without our giving them more. But this toxicity question is a difficult one. I can't give you the answer to it. I can only prove to you that we do not know the answer, because we had a city of 18.000 people which was fluoridating its water for six or eight months. Then a campaign was started on the grounds of its toxicity. It ended up in a referendum and they threw out fluoride. It's tough. When we are having the Press in, and the public in, don't have anybody on the programme who is going to go ahead and oppose us because he wants us to study it some more. That is rather an interesting sidelight upon the way in which this campaign has been carried on—and we are being asked to imitate what has been done in the United States. I could quote a good deal more of a similar character, but that sufficiently illustrates the nature of the campaign.

It is not my purpose to-day to argue in detail the case against adding sodium fluoride, or other fluorides, to water supplies, but the announcement by the Minister of Health that he approves of this being done makes it imperative that I should say something more about it. The whole question of the addition of chemicals to foodstuffs was exhaustively examined by a Select Committee of the American House of Representatives, under the chairmanship of Congressman Delaney. They devoted a considerable amount of time to this particular question and took a great deal of evidence, both from advocates of fluoridation and from a number of eminent physiologists and pathologists who gave reasons why they considered this practice to be risky or dangerous. This evidence was made known, of course, to the members of our Mission, but it is dismissed in a very brusque fashion. They do admit, however, that Fluoridation involves a degree of calculated risk. What does this comment mean? If the word "calculated" is intended as a synonym for "deliberate" or "intended," it is correct; but if it is intended to mean that the risk is known and can be estimated, then that statement is simply not true. Moreover, the benefit, if any, is confined to children, while the risk is distributed over the whole population.

What is this risk? I am going to quote now from a paper by Professor D. G. Steyn, who is Professor of Pharmacology in the University of Pretoria. South Africa is a country where natural drinking waters are found containing fluorides, and the effects have been the subjects of scientific study. Professor Steyn says: Fluorine is a dangerous poison in that its chronic harmful effects may not be in evidence until thirty or forty years after consumption of minute quantities of this poison had begun. In addition to our previous knowledge of the harmful effects of fluorine in drinking water, it was recently established that small quantities of fluorine in drinking water suppress thyroid activity, and in our fluorine areas endemic goitre is of frequent occurrence. How does this tie up with the plan for adding iodine to salt in order to combat endemic goitre? Will the dosage of iodine be increased still further if fluorides are added to the water supplies? Professor Steyn continues: An aspect of fluorine poisoning which needs investigation is the characteristic of this halogen to form a chemical combination with calcium phosphate in the teeth and bones. The nature of chronic fluorine poisoning is such that in order to study it fully, experiments have to be conducted over a number of generations of animals, as the hones and teeth of each succeeding generation will contain more fluorine than those of the preceding generation. In this tendency of fluorine to accumulate in the hone system lies the greatest danger of chronic poisoning when small quantities of this poison are ingested daily over long periods.

Here, my Lords, I would make two comments. Have the Government the intention of adding more chalk to flour, in order to counteract the immobilisation of calcium by fluorine? Do they intend to experiment for several generations on the unfortunate communities whom they select for what the Minister calls studies of the various aspects of fluoridation? Professor Steyn also points out that the ingestion of fluorine during pregnancy and lactation needs special attention and care as excessive quantities may harm mother and fœtus and suppress lactation, as this poison has an antithyroid action. This brings me back to the fundamental principle, that procedures of this kind are the antithesis of rational medical science. The drug is administered to everyone, whether with teeth or without, whether young or old, without regard to physical condition or susceptibility. It is, therefore, a reckless and unethical practice. All such practices are an invasion of the liberty of the subject which should not be tolerated in a free country. I beg to move for Papers.

3.32 p.m.

LORD AMULREE

My Lords, we have just listened to a detailed and extremely plausible story put forward by the noble Lord who moved the Motion. However, I should like to issue a gentle warning about some of the general things which he said. If one takes one's self back to the sixties of the past century, one finds that there was then a great deal of correspondence and many leading articles in The Times about the campaign by Edwin Chadwick Ito try to stop cholera, to try to make people drink clean drinking water, and to tidy up the town generally. I have not the exact quotation, but The Times said that they would rather die dirty than be cleaned up by the board which Edwin Chadwick was proposing to set up. I feel that that has a certain bearing on what the noble Lord, Lord Douglas of Barloch, has just said.

One of the things which he said with which I do not agree is that the practice of putting drugs into various foods and water supplies is a negation of medical practice. There I cannot agree with the noble Lord, because I think that assumes a wrong view of what a doctor is for. A doctor does not exist primarily to cure his patients. Of course, he must cure them if they are sick; but he is there primarily to stop them from becoming sick. That is the prime reason why we have a National Health Service, and the prime reason why doctors exist. I should have thought that if, by adopting a certain number of simple measures, you can prevent a certain amount of disease, then you are not only doing good for the community, but you are carrying out an economic work as well, which, of course, can be equally important.

The noble Lord referred to the amount of chlorine put into water at the present time. That practice was largely started during the war, to meet the danger of contamination of the water as a consequence of bombing. For that reason, all the water supplies in the country, including even the small ones, were chlorinated. So far as I know—and I know a little about it, because I was involved in some of the work at the time—there was no complaint that this would do anybody any damage. There were a few complaints that it made the water taste nasty—and it tasted filthy at times—but it did no harm whatsoever. I believe that an experiment on that scale, carried out over a period of four or five years, with no evidence of damage done to anybody, roust mean something.

The same point applies to what the, noble Lord said about putting chalk into bread. Put as baldly as that, the proposition to mix chalk will flour does not sound very attractive. But that, again, was the result of certain work done during the war, when the extraction rate of flour was stepped upwards, which meant that the calcium in the bread was turned into something insoluble. Calcium is an important part of diet, and if one does not get sufficient of it one tends to suffer from various complaints which are preventable by the addition of chalk to the flour. This was done during the war, and I believe there is still chalk in what is called "National" bread, because that is made from flour of almost the same extraction rate. But, so far as I know, there is no chalk in the white flour, and if people like to buy wholemeal flour there is no chalk in that, either. There is the choice for the public. If they want chalk in their bread, they can have it, but if they do not, they are not compelled to. Curiously enough, most of the people do not take to the white or the wholemeal flour, so there cannot be a great deal of feeling about it.

The same argument applies in regard to pulling iodine into salt to counteract goitre. I have heard figures given of about 250,000 to 300,000 young people in this country who suffer from goitres, some of which are bad and some not. That is an appreciable number, and if this complaint can be prevented by the addition in small controlled quantities of iodine to salt, then I can see no objection to it, particularly as I believe that if such a scheme were to be introduced it would be possible, if one did not wish to have iodised salt, to buy non-iodised salt from the same shops where the iodised salt is sold. The question of putting fluorine into water is, to my mind, a much more difficult one. A great deal of work has been clone in the United States which shows that apparently it stops dental caries. I should have thought, however, that that is not entirely proved. and I feel sure that the Government will not embark on any widespread attempt to put fluorine in the water supplies, or if it is done, will merely raise the total quantity to one part per million, which, so far as I know, already exists in many of the water supplies of the country. That would merely bring up to that level those water supplies which are at present below it, and would not increase the amount of fluorine to an abnormal degree. As people have been drinking water with one part fluorine per million parts ever since water was first drunk, with no great trouble, I cannot see any particular danger in that. But fluorine can be a dangerous thing, and in big doses it could cause a lot of trouble. There are some countries in the East where there is a considerable proportion of fluorine in the water, and the people do suffer from serious bone damage. But there is no question of that occurring with the amount that we have now, and which, as I say, will never go above a normal amount. I do not want to follow the noble Lord through all the points he mentioned, but I trust that your Lordships will not accept his Motion.

3.40 p.m.

LORD WEBB-JOHNSON

My Lords, we must keep an even mind on this subject, although there inlay be some mass effects threatened. We must bear in mind, in the first instance, that what was written in the Scriptures, They that be whole need not a physician, but they that are sick, must not be taken literally, because the attitude of the medical profession towards I disease has changed radically in the last century. We are no longer agents for the recognition and treatment of disease, but are pioneers in efforts to prevent it. As Oliver Wendell Holmes said, "to guard is better than to heal." We do not aim at prevention—that is too wide a term to use. But we do aim to guard the helpless young and the people living in certain districts deficient in the requirements for a healthy life, and we do aim to protect them from the disadvantages under which they live.

Every new idea in medicine has had to fight for acceptance against opposition—not only from outside the profession but also from within it. Vaccination, anæsthesia and the resistance to Lister's teaching of antiseptic surgery are startling instances enough. But a new truth is often opposed either by a fixed opinion or by a bias, and one has to be careful to find out whether the opposition is based on scientific principles, or whether it arises because of this total conservatism which seems to have permeated into the Opposition side of the House. We must remember that the men who have brought new knowledge and made suggestions for increasing health are not men who are exploiting a new idea they are earnest, pious, men. Lister was one of the most pious men who ever walked this earth. And what did Ross, when he discovered that the mosquito was the vector carrying the infection of malaria, write in his notebook the night it was revealed to him? This day relenting God bath placed within my hand a wondrous thing, and God be praised! Those who make great discoveries are not trying to force something on to thinking people: they are trying to convince a majority of their fellow citizens that by a certain procedure disease may be prevented or its incidence lessened. I am shocked to find a Scotsman—I presume that the noble Lord, Lord Douglas, claims some attachment to that country—adopting his present attitude, because, after all, Scotland was the native country of John Hunter. John Hunter was the founder of scientific surgery, and when his friend Edward Jenner wrote to him and said, "I think so and so," John Hunter replied, "Why think? Why not try the experiment?" The noble Lord, Lord Douglas, seemed to be intent on preventing us from trying the experiment. The experiment may be a bit more frightening if it is to be applied by mass methods, but it may be that the truth can be found only by that means, and not by observation of individuals; so I do beg the noble Lord to keep an open mind.

I myself have seen attempts at the improvement of the dietary attacked sometimes by methods akin to blackmail. In a recent debate, the salt that has be slogan, "See how it runs!" was condemned because it was not sodium chloride. An attempt was made to ruin the man who introduced that by propaganda to the people. They were asked: "Do you know what you are swallowing?—phosphates. What is phosphorus?—one of the most terrible poisons that can be swallowed. And that is what is in this salt that you can see how it runs!" But have we seen any holocaust as a result of taking salt that did run? of course, the noble Lord probably wants to go back to the day when we all rejoiced in going to the kitchen arid finding blocks of salt, grinding them together and getting it into salt-cellars. But we did not similarly rejoice when the salt all became caked in the salt-cellars. Does the noble Lord, Lord Douglas of Barloch, object to the chlorination of water when troops are on the move? Does he object to the chlorination of water in war time, when drains have been blasted and when the water supply may be infected? Does he object to the ozonising of air? Most of our life to-day is based on the discoveries of Pasteur.

Let me deal with one or two of the special things which the noble Lord has mentioned. Iodine is an essential to the healthy functioning of the thyroid gland. Look at the condition of people who have a complete upset of their iodine metabolism. Fifty years ago, when I used to go to Switzerland to see Kocher operating on goitres, there was no idea of how this incidence could be prevented or diminished. Then, thirty years ago, when I went to Cleveland, in Ohio, I saw George Crile operate on twenty goitres in a morning. Do you think he enjoyed doing that? No; his whole object in life was to find out why these people were getting goitre, and how to prevent it. Only last week his son was over here, and I asked him how many goitres he did in a day in Cleveland He said, "Possibly one or two, and some days none." I asked why, and he said, "Well, things evolve." I said, "Is it because you have iodized salt?" He said, "Well it may be, but we do not dismiss other possible factors. For instance, in goitre areas to-day half the vegetables that are eaten by the citizens are grown outside the district. They are grown out in the West, where the soil is saturated with iodine, and they get their iodine through canned vegetables." These things right themselves. But that is no reason why we should condemn those pioneers who, in the early days, first proved that a certain disease was due to a deficiency of iodine and, secondly, urged that steps should be taken by artificial means to meet the deficiency.

Then we conic to the fluorine question. We know that experiments have been carried out in New Zealand and other places. The British Mission that went out to New Zealand reported on the experiment there, and we know that it has been carried out in America. There are two alternatives available to help the youngsters: one can either make local applications of fluoride to the gums, or one can see that they get proper fluoride intake. Well, my Lords, Lord Douglas would wish that … the whining school Soy with his satchel, And shining morning face, creeping like snail Unwillingly to school … should have still another deterrent: that he is going to meet the dentist who will swab his gums with fluorine, whereas if he had a nice dose of fluorine in his morning tea or coffee there would have been no necessity. I wish to protest against the suggestion that "mass medication," as the noble Lord calls it, is contrary to the ethics and traditions of the medical profession. The proposal which he has criticised is not "mass medication"; it is a reinforcement of nature's supply in a particular district. In the matter of fluoride, it is ten years (and Lord Douglas talked about our being in a hurry!) since Weaver's paper in the British Dental Journal pointed out that the incidence of caries of the teeth in South Shields was half what it was in Tynemouth. There is not much hurry, surely, in suggesting that something should be done about this matter. If the noble Lord has not the reference, I have it here.

I must not detain your Lordships too long, but I must say that I object to the noble Lord's remark about "adding drugs to the water supply." All that is being suggested—if it is actually being suggested as a practical proposition at the moment—is the addition in a particular district of something in which nature has been deficient. The noble Lord referred to an experiment that was abandoned after six months of public outcry. I am not surprised, when I see the nature of the public outcry. There is no limit to the lengths to which the opponents of sanitary measures will go. From cancer downwards, the whole gamut of diseases are paraded as dangers. Take fluorinated water: it is all there in black and white, down in print. I am not exaggerating—that is what they have done. Lord Douglas, referring to fanaticism, applied that description to those who were urging that something should be done. Am I not justified in applying the term to the noble Lord himself, who complacently holds the last ditch and tries to prevent anything practical from being done in the matter? The noble Lord quoted Tennyson; I, too, should like to quote Tennyson: Let knowledge grow from more to more, But more of reverence in us dwell …

3.49 p.m.

LORD HANKEY

My Lords, the very wise speech to which we have just listened leads me to a conclusion which I reached before I came here—that the truth lies somewhere between the extremes on both sides in these matters. I have great sympathy with what the noble Lord, Lord Douglas of Barloch, has said, and I listened with the greatest interest to the admirably documented discourse which he gave us. The other speeches also much impressed me. My own feeling is that the term "mass medication" is not quite appropriate. The word "medication" seems to me to savour of medicine; and medicine to most people—and I believe it is also suggested by the dictionaries—savours rather of cure. But a great many of the substances which are added to food or drink are prophylactic rather than curative; they are supplementary, very often, to something that is already in the food but is not believed to be present in sufficient quantities to give the greatest benefit and the greatest nutritional value. Moreover, I feel that if a term of this kind is to be used it should be much wider—wide enough to include the so-called improvers, for which usually neither curative nor prophylactic advantages are claimed, although they may he dangerous. I think it should be wide enough to include abstraction of valuable elements. In fact, reading through, as I did last night, the revised Food and Drugs Bill I found that the first clause gives definitions which would cover all these aspects of the question. If not "mass medication," what should the expression be? I do not think we have got the right term. "Mass manipulation" or "mass interference" strikes me as rather more appropriate.

However, whatever the nomenclature, I want to make a particular point which has already been touched upon: that Government must have tremendous latitude in these matters, especially in emergency and more particularly in war. I myself, like the noble Lord, Lord, Amulree, was very much concerned about the question of the chlorination of water, because I was the chairman of the scientific committee which consisted mostly of medical men and included members of the Medical Research Council of the Ministry of Health, and other experts from outside. This body recommended that steps be taken as a matter of great urgency—and it really was a matter of great urgency, because although the question arose in the early days of the war we were looking forward to the time when we should be getting the blitz and we knew that the blitz might create great dangers for the population, owing, for example, to the fact that sewers and water supplies were adjacent. I do not think there is any doubt that those steps averted a very grave menace. Moreover, we could not at that time exclude the possibility that there might be a deliberate effort to introduce poison or dangerous bacteria from the air or by sabotage. Therefore I urge most strongly that there must be a great deal of elasticity in applying principles of this kind. In fact, my impression is that it is difficult to generalise in these questions and that every case has to be considered on its merits.

There are three particular cases, which, however, I am not going to discuss in detail. I understood Lord Amulree to say that if one consumed wholemeal bread one would not get any chalk. I have been an advocate m this House, since the first year I joined it 1938, of the consumption of wholemeal bread, and I have reached the point now when no white bread ever appears in my household. I believe it to be a primary cause—I touch wood—of the good health that I have enjoyed. I shall come back to that point in a moment. So, at any rate, there is a cure; and every day more wholemeal bread seems to become available in the shops. Then let me take the case of the iodised salt. I am not competent to say more on that matter without having had an opportunity to check the facts, but my impression is that I always eat sea salt and that that is naturally iodised; so I may be taken as a biased witness in that respect.

I should like to say a few words about the addition of fluorine to water. I have been interested in that for some months, since a visit I paid to the London Water-works. I have read a good deal about the subject, but what, I have found to be the most illuminating document on the matter is a pamphlet by Colonel E. F. W. Mackenzie, who was until recently Director of Water Examination to the Metropolitan water Board, although he does not claim to commit the Board to his views, even though they published his memorandum. His claim is the same as that which your Lordships have heard to-day, namely, that the addition of a small quantity of fluorine to our water supplies would be followed by a huge reduction of caries in the teeth of children during the formative period. He supports his claim by a mass of evidence of large-scale experiments in America, and experiments on rather a smaller scale here but leading to the same result. At the time his pamphlet was published, no fewer than 1,700,000 people in twenty States of the United States of America had been receiving water with a fluorine content on the appropriate scale. The teeth of a large proportion of the children had benefited, and benefited greatly, and. it was expected that in many cases that improvement would be prolonged into later life. I think the noble Lord, Lord Douglas of Barloch, rather throw doubt on that belief. I do not pretend to be a judge. It is claimed that no one, man, woman or child, was a whit the worse except in some districts where, as has already been said, natural fluorine was present in proportions much above what is used in the case of artificially added fluorine, and then the damage done was the mottling of the teeth.

I find all this immensely stimulating and encouraging but there is the other side of it, and that side, I think, is very serious. It has been deployed already and I shall give only the points that rather appealed to me. To begin with, the pamphlet from which I have been quoting, which is a very fair presentation, admits that the poisonous nature of fluorine is a serious matter; but until I entered this Chamber, I had not been able to discover what the effects were. I have listened with great interest to what my noble friend has said on that subject, and it sounds pretty serious.

That raises the question whether, after seven or eight years, admittedly of experiment, there is enough knowledge of what the long-range effects of fluorine are on the human constitution as a whole. What the South African professor said seemed to me very important in that respect, but, in view of our own experiences of the long-range effects of what has happened to our daily bread, I think we have to be careful. After all, it was fifty years before it was realised what was the cause of the disease to our teeth which gradually followed the introduction of the steel rollers. Then, in the case of agene, it was twenty-five years after its introduction before the results of Mellanby's ex-perinaents were published. In view of that, my own feeling is that it would be more advisable not to hurry over this matter but to get some more experiments done. In any event, I agree with my noble friend Lord Douglas of Barloch that it is rather excessive to subject to this process the whole of the population, a large proportion of which will certainly object, in order that there may be benefit to a percentage—a large percentage if you like—of young children. The obvious way out is to find some way of giving fluorine, with it admitted benefits, to children during their formative years. In America various methods have been tried to do this by means of pills, tablets and even chewing gum, but without any real success. I have brought this point forward because I believe that possibly there is a way out.

In another part of this pamphlet, Colonel Mackenzie mentions that, as long ago as 1892, the late Sir lames Crichton- Browne, in an extraordinarily prophetic address to the British Dental Association in the Eastern Counties, suggested as a specific cause of the rising incidence of dental caries the increasing abstraction of bran that was being practised in the milling of white flour, and he quoted Dr. George Wilson as having shown that the husky parts of wheat were the main source of fluorine intake. He regarded fluorine as the characteristic chemical constituent of tooth enamel and came to the conclusion that: a supply of fluorine, while the development of the tooth is proceeding, is essential to the proper formation of the enamel, and that any deficiency in this respect must result in an inferior enamel. Does not that suggest to us a pointer? It looks as though the much abused bran which some of my noble friends and I have been defending for a very long time had merits which I, for one, had not guessed at. If Sir James Crichton-Browne was right, as he generally was, a perfectly natural as opposed to an artificial method of administering fluorine may be in sight. I therefore venture to suggest to the Government that they should bring this matter to the notice of their experts, and ask them to follow it up, for it would certainly be much easier to feed young children on wholemeal bread. We know that a great deal can be, and has been, done by Government action, in persuading mothers to give children other things, such as orange juice and the like, and it would not be difficult, I should think, to extend that persuasion in regard to wholemeal bread. It is already supplied in a good many of the private schools.

Before I conclude, I should like again briefly to refer to the question of agene, because that is a subject which, in ordinary circumstances, I should certainly have raised on the question of bread. I do not propose to go into it in full, however, because I am quite satisfied that Her Majesty's Government are doing their utmost to carry out the frank and definite assurances that my noble friend the Joint Parliamentary Secretary to the Ministry of Agriculture and Fisheries gave the House on June 10—namely, that the Government will abandon the use of agene as soon as a suitable substitute can be found. I was informed on December 2 last by the noble Viscount, the Chancellor of the Duchy of Lancaster, in a Written Answer to a Question, that good progress was being made with the investigation but that another three months would be required before a statement could be made. So, naturally, I am not going to ask prematurely for a statement. I have so much confidence in them that, if the Government want a little more time, as I think from an Answer given in another place they may, I shall not be troublesome in any way.

I should rather like to say why I think the progress is good. First, there has been a great deal of propaganda work by women's institutes all over the country, which seems to have had considerable effect, and also there is evidence that hard-headed businessmen are starting to apply the new measures which are beginning to take shape. There is undoubtedly a great increase in the consumption of wholemeal bread—anybody who looks in the windows of bakers shops will see the larger supplies of it. As I have said before, the amount of wholemeal bread now available is much greater than hitherto. Then, there is the spread of compost-grown bread. I myself have seen queues in the shops which advertise compost-grown bread. I was much stimulated to read that one of the largest producers of wholemeal bread (I have their advertisement in my hand) have now produced a form of compost-grown wholemeal bread. I have also an advertisement which appears in the weighty columns of the British Medical Journal, which includes these words—it is an advertisement in regard to some form of crisp bread: No extraction, nor the addition of agene or so-called improvers. Only a few days ago I received a large poster put out by a large concern of millers and bakers in the West Country. It bears the caption: All our bread is made from flour free from chemical treatment. Those things are pointers. Coming events cast their shadows before them, and I am now more confident than ever that this year will pretty nearly see the last of agene.

4.17 p.m.

LORD GLENTANAR

My Lords, we have listened this evening to some very interesting speeches. I should like to support one thing stressed by the noble Lord in whose name the Motion stands—in fact, it is inherent in his Motion; namely, his objection to the use of a large section of the public for the purpose of an experiment, whether they would wish it or not. Let me start with bread. As has already been said, one can get other kinds of bread—such as bread without the addition of calcium; therefore, I do not think that is so serious. One can get salt without the addition of anything to it, especially iodine. But in the districts where it is proposed to treat water with fluorine it would be difficult and extremely expensive if one were to try to obtain water from elsewhere. So I think there is a radical difference between the proposed experiment of adding fluorine to water and the addition of substances to either salt or bread.

With regard to the measures which have been adopted in the United States of America, many of your Lordships will no doubt have read the excellent Repot, which has been referred to, made by the United Kingdom Mission. I should like to restrict my remarks on this subject principally to things which have been said in this Report because, although the Mission have not given as much weight to the possible hazards and dangers as has been given elsewhere, they certainly have not ignored them. In section 26, which begins under the heading "Possible hazards," they quote the words of the Select Committee to Investigate the Use of Chemicals in Foods and Cosmetics. This Committee is usually known as the Delaney Committee, and the passage is taken from their Report—which has already been referred to in your Lordships' House to-day—to the House of Representatives. In effect it is a quotation of a quotation. The Committee stated: The area of controversy concerning the fluoridation of water arises over the question whether a sufficient amount of investigation and study has been completed to justify a recommendation of universal application of this procedure at this time. … The majority of scientific opinion is that fluoridation of drinking water in amounts up to one part per million of fluorine is safe. The view of the minority group is not that it is known that the ingestion of fluoridated water at one part per million will result in injury to health but rather that it is not known with any degree of certainty exactly what subtle physiological effects may ensue, and that a number of important questions still remain unanswered. Those of your Lordships who have studied the Report of the American Select Committee to the House of Representatives may feel that this minority group represents a considerable number of expert people, whose views cannot lightly be set aside.

If we turn then to the recommendations of the United Kingdom Mission we find that they themselves advise considerable caution. With regard to the "study centres," as they call them, which it is proposed should be set up to consider the subject of mass experiments, they say that before these fluoridation studies can be started It is necessary to obtain baseline information on the incidence of dental caries in children and adults in the selected communities … and so forth. They go on to state that it is also necessary to assess the required dose of fluoride to be added to water supplies in this country. We have seriously to consider those recommendations. I do not want to go into the merits or demerits of the addition of fluoride to a water supply, but it must be remembered—as has been stated in the Report to which I have just referred—that fluorine exists not only in water but also in food and the dust in the air, so that the total intake of a person is not limited to that which he gets by way of water. In conclusion, I would only urge, as the noble Lord, Lord Hankey, has already done, that in this important investigation we should hasten very slowly, because it is obvious that before long a great deal of important information will be coming from those countries which are already making these experiments, and especially from those which have carried out this addition of fluorine to water on a very large scale. The figures they will provide, and the facts which they will discover, will put us in a very much better position in introducing this system into this country, should we so decide to do.

4.26 p.m.

LORD CALVERLEY

My Lords, I shall intervene for only a few minutes if you will bear with me. I was sad and sorry to note that Lord Webb-Johnson was less than fair when he criticised my noble friend Lord Douglas of Barloch. But I am fortified because I know that Lord Douglas is ready to stand like Horatio—as indeed are other speakers in this House —when he brings forward Something which he believes to be right. But I was disappointed in the speech of Lord Webb- Johnson. I wanted to hear him say something about chalk, but he never mentioned it.

LORD WEBB-JOHNSON

I saw enough of chalk when I was in statu pupillari.

LORD CALVERLEY

The point is that we have it on the authority of Lord Hankey and others that we are now eating too much chalk. I do not know what effect it has—or perhaps I should say that I do know what effect it has in a certain direction. But your Lordships will not expect me to go into questions relating to constipation or anything like that, and I will leave that matter alone. With regard to chlorination I would just say this. Chlorination had to be carried out during the war, but I believe that the Water Board in London, not having had as much experience as authorities in other parts of the country, over-chlorinated the water here. The result, so far as I could judge, was that the water did not make a very good cocktail; and I did not drink it myself if I could avoid it. I am with Lord Webb-Johnson when he advocates the use, on medical advice, of iodine. We have in the North Midlands a disease called "Derbyshire goitre." I believe that it is now dying out because of the use of iodine.

I was much troubled, however, because Lord Webb-Johnson never mentioned agene. I wanted some cheap advice from him on the merits or demerits of agene. I am told that it is an American importation, and that it is especially well known in Wisconsin, which I believe is a great grain-growing State. We are told on high authority that there dogs go mad, and that if a politician bites a dog the politician goes mad also—indeed, that seems to have happened in the case of a few politicians who dwell in Wisconsin. To be serious, we laymen look towards, and are ready to listen to, our medical advisers, especially if they will give us a prescription for something that is very nice. But I should like to know whether our food is being tampered with, and whether our digestions are being ruined by too much chalk. With regard to this agene business there is only one good result that I can see, and it has been mentioned by Lord Amulree, who speaks with great authority on such matters. I gather from the noble Lord that agene makes the flour rise; therefore there is plenty of gas in it, and gas is good for politicians, it may be said. I hope that the noble Lord, Lord Carrington, in replying to the debate, will be able to give us some authoritative statement this afternoon. I think that the people who live in this realm are being slowly murdered by agene, chalk and chlorinated water and the noble Lord may even tell us something about it.

4.30 p.m.

THE JOINT PARLIAMENTARY SECRETARY, MINISTRY OF AGRICULTURE AND FISHERIES (LORD CARRINGTON)

My Lords, all your Lordships will know by now of the great interest which the noble Lord, Lord Douglas of Barloch, takes in the question of foodstuffs and their purity, and this afternoon he has raised the subject once again. Listening to the speeches of the noble Lords, Lord Webb-Johnson and Lord Amulree, it seemed to me that they so successfully demolished his case that, but for the fact that I am speaking for Her Majesty's Government, and therefore ought to say something on the subject, it would not have been necessary for me to delay the House for more than a few minutes.

The noble Lord's Motion seems to me to raise three questions. First, are the projects that he has mentioned in his Motion—the addition of chalk to flour, of iodine to salt and of fluorine to public water supplies—really mass medication? Secondly, why are they thought to be necessary, and are they dangerous to the health of individuals? Thirdly, assuming they are justified on medical and scientific grounds, should they nevertheless be withheld or withdrawn, on the grounds that they infringe the liberty of the subject or that they carry with them the risk of injury to the health of individuals? I should like shortly to reply to these three questions.

Taking the first: are these projects really mass medication? Certainly the examples which the noble Lord quoted in his Motion are not medicaments as usually understood, but are more measures designed to ensure that the people of this country have in their diet a sufficiency of certain substances that have been found to be essential in order to maintain good health or prevent disease. It has been found that in the diet of large numbers of the population there are serious deficiencies of these things, and the question is not one of treatment or cure, bat whether it is in the general interest that the diet of the people of this country should be adequate in these particular elements.

I should like now to go more fully into the specific examples which the noble Lord has given. First of all, he mentioned the addition of chalk to flour. I know that Lord Douglas himself is not under any misapprehension, and I knew that the noble Lord, Lord Hankey, is not either. It may be, however, that some of your Lordships remember a debate last June in which the noble Lord, Lord Hankey, talked of the addition of chalk to flour in the early 18th century, when there was a popular craze for white food, and the adulteration of bread with chalk followed, and quoted Matthew Bramble as saying "The bread I eat in London is detelerious paste mixed up with chalk" This, of course, is not the reason why chalk is nowadays added to the flour. It was recommended by the Committee on Nutrition of the British Medical Association that the consumption of calcium should reach 8 of a gramme per adult per day. The danger of deficiency still exists, in spite of the large increase in milk consumption during and since the war. And, after making proper allowance for wastage, the National Food Survey showed that in the first half of 1952 the national average intake of calcium would have been about 10 per cent. below this requirement, had it not been for the addition of calcium to flour.

The Committee on Medical and Nutritional Problems, which is under the Chairmanship of the Chief Medical Officer of the Ministry of Health, has also strongly recommended the addition of calcium to flour and I can assure the House that this does no harm to anyone. I hope that that will set the mind of the noble Lord, Lord Calverley, at rest. As the noble Lord, Lord Douglas, will know, the one permitted omission of calcium is from 100 per cent. extraction wholemeal flour. This is a concession to those who hold strong views on the merits of wholemeal flour. In any event, it is believed. that those who eat this flour are likely to get sufficient calcium from other sources. It may well be that the good health which the noble Lord, Lord Hankey, enjoys—and we are all glad that he does enjoy it—is due to this, as well as to the reason he has given us.

The second example which the noble Lord, Lord Douglas of Barloch, quoted was the iodisation of salt. The Medical Research Council in 1943 set up a special committee to investigate thyroid diseases and to make recommendations for its control. The sub-committee reported in 1948 that goitre seemed to be on the increase, and they urged strongly that preventive action should be taken on a national scale by the addition of a trace of iodine to salt used for domestic purposes. This recommendation was en dorsed by the Committee on Medical and. Nutritional Problems of the Ministry of Health and was then referred to the Ministry of Food, so that the Food Standards Committee could investigate the technical problems of carrying out the recommendation. Since then, the practical problems of introducing the recommendation have been reviewed several times but have not been fully solved. As your Lordships may know, in 1950 the Food Standards Committee recommended favourably in a Report published in March of that year. Representations were received from a large number of people, including the medical profession, the trade, medical authorities, various women's organisations and members of the public. These representations were considered by the Health Departments and by the Food Standards Committee. In passing, I may say that in a number of countries where goitre is very common salt has been iodised for a number of years, and nowhere has there been any resulting harm; in fact, the experience of these and other countries is that nothing but good has resulted.

The practice has been current in Poland since 1935 and in Switzerland since 1922. One survey in Zurich from 1939 to 1944 showed that when the proportion of iodine was increased from 5 to 20 parts per million the proportion of infants born with goitre decreased from 25 per cent. to 6.8 per cent. It is interesting that experience in Switzerland suggests that in parts of that country the increased occurrence of goitre in recent years may be due to greater technical perfection in the manufacture of salt. For instance, up to 1900 the salt in the Canton Vaud, taken from a local mine, contained 10 parts of iodine per million and during that time the incidence of goitre was low. From about 1900 the local salt was increasingly refined, and goitre started to increase to a high level until iodisation was begun in 1924. There have been similar experiences in West Virginia. In Canada, the iodisation of all salt for table or general household use has been compulsory since 1949, and we have not so far heard of any difficulties or ill-effects arising there. The Food Standards Committee, however, have not yet made their final Report, and no decision has yet been taken. I know that my right honourable friend the Minister of Food will take very careful note of the representations made by the various interests and, of course, of the remarks which have been made this afternoon in your Lordships' House.

The last example which Lord Douglas of Barloch gave was the fluoridation of water supplies. As the noble Lord will know, it is necessary during childhood and adolescence to take flourine, either in food or in drink, so that normal teeth and bone can be produced, and its absence in sufficient quantities may result in bad development. An interesting example of this, which the noble Lord, Lord Webb-Johnson, mentioned, was given by a survey in 1944 of 500 children aged twelve in North Shields and of the same number in South Shields. In South Shields, there are natural fluorides in the water, but in North Shields there are none. This survey found that the average number of permanent teeth decayed, missing or filled in North Shields was 4.3 and in South Shields was only 2.4. In North Shields, the percentage of children without any decayed, missing or filled teeth was as low as 4.8, while in South Shields it was 25.8.

Experiments, too, in the United States, which the noble Lord mentioned, have shown that where the amount of fluoride is of the order of one part per million there is a reduction of about 50 per cent. in the occurrence of dental caries among children, as compared with areas where there is little or no fluoride in the water. A Scientific and Medical Mission was sent to the United States and reported in July, 1953, that similar results could be expected in Britain, and as this is the only measure which up to the present time gives any promise of preventing or reducing the incidence of bad teeth, the Minister of Health announced on December 3 that the Government accepted the recommendations of the Mission. I should say, of course, that there are a considerable number of areas in England and Wales where there is already enough fluorine in the water supply, in which case no more would be added. If the noble Lord, Lord Douglas, lived in one of these areas—and for all I know he does—he would take fluorine in probably almost the same quantity as we propose to add to water supplies to bring, them up to a regular dose of 1.0 to 1.5 parts per million. There is no scientific basis for the allegations that fluorides in such quantities have had any harmful effect on anyone, but I do know that there has been some confusion with industrial fluorosis, which is the result of a heavy concentration of fluorides in the atmosphere in the form of dust.

The last question which the Motion of the noble Lord, Lord Douglas, raises is that, even assuming that these measures are medically justified, they should nevertheless be withdrawn or withheld on the grounds that they infringe the liberty of the subject—I think he even said that they were obnoxious and immoral. I agree with the noble Lord that this is a much more difficult problem, and it seems to me that one can strike a balance only by going fully into each proposal. I do not think that the noble Lord suggests that, if it becomes known that certain elements which are essential to health are missing from the diet of a large number of people of this country, the Government should sit back and do nothing. Certainly I have the support of the noble Lord, Lord Hankey, because in a debate we had on June 10 last year he made a quotation, and said (OFFICIAL REPORT, Vol. 182, col. 821): May I recall once more the Resolution that I quoted earlier—namely, 'that the health of the population should be the guiding principle to govern the nutritional policy of the Government …that in applying that principle to the case of bread, the health of the consumer should be the primary factor, and milling and other interests should be developed in harmony with this policy'. He went on to say: My Lords. I am afraid it cannot be said that the health of the consumer has been considered first in this matter. I know from that that Lord Hankey supports me when I say that it is essential that the guiding principle should be the health of the population. And I should imagine that the noble Lord, Lord Douglas of Barloch, would agree with that.

On the other hand, I agree that medical justification is not of itself sufficient to justify the adoption of any particular treatment. We must, of course, consider the political and philosophical implications of our actions. A man is on firm ground if he says, "What I eat is my own affair and no one else's. It does not affect other people, and therefore tie State has no right to dictate to me what I must eat." This point of view has the support of some of the best political thinkers, including John Stuart Mill—and this should appeal to the noble Lord, Lord Amulree. Mill would almost certainly have put the choice of one's diet into the category of what he called "self-regarding action." There is a passage in Mill's Essay on Liberty which I should think would apply very well to a person of Lord Douglas's opinions. The passage goes like this: Considerations to aid his judgment, exhortations to strengthen his will, may be offered to him, even obtruded on him, by others: but he himself is the final judge. All errors which he is likely to commit against advice and warning are far outweighed by the evil of allowing others to constrain him to what they deem his good. This, we would all agree, is a sound principle which Governments must recognise. The only trouble is that, like most political principles, it tends, in extreme cases, to clash with others which are just as good.

Nowadays, we believe that the Government have a general responsibility for ensuring the health of the people. The noble Lord, Lord Douglas of Barloch, and others, when they urge us to ban the use of agene in bread, and the use of poisonous substances for killing weeds and insects, appear to accept this principle. It does not necessarily mean that the State must always act on scientific advice and force people to do what scientists think is good for them. We all know that the experts of to-day are sometimes contradicted by the experts of to-morrow—if not also by other experts of to-day. But I submit that the principle does mean that when an overwhelming case has been made out on scientific grounds, when we are convinced that what is recommended is practical and cannot possible result in anything but good to the public health, then we must consider taking action of the kind which the noble Lord, Lord Douglas of Barloch, describes as mass medication. The Government would be failing in their duty if they did not take into account the great benefit to public health which would result, as well as giving due weight to the political scruples which the noble Lord has raised,

4.47 p.m.

LORD DOUGLAS OF BARLOCH, replying to the debate, said: My Lords, I am grateful to all those noble Lords who have taken part in what has been an interesting discussion. If would, not attempt to cover all the points which have been raised during the course of the debate. I agree with the noble Lords, Lord Amulree and Lord Webb-Johnson, that the most important task which a doctor can undertake is to prevent disease rather than to cure it. I have held that view, and clone my best to promote it, for quite a number of years past, not with a great deal of success, perhaps; but still I am encouraged that two eminent members of the medical profession should put that in the first place. But let us go just a little stage further than that broad generalisation and consider its application to the kind of cases which we have been discussing this afternoon. If you are going to prevent ill-health, then I should have thought that the first question which you should ask yourself is: What are the causes of ill-health; and what are the causes, let us say, of what we have been discussing to quite a considerable extent this afternoon, dental decay? There is a good deal of knowledge about that subject. We know that there are a number of races—the Aboriginal races in New Zealand, the Bantus in Africa, and others—who had perfect dentition until they began to consume European foods and abandoned their traditional diets. We know that in countries such as this country and the United States undoubtedly one of the greatest causes of dental decay is the use of highly refined flour and other carbo-hydrates and the ingestion of large quantities of highly refined sugar. These are the admitted facts which are known to everybody.

Now let us apply the noble Lord's principles to this case. Is the administration of fluorine remedying the cause, or is it in effect a medication? If you are to prevent this decay from happening, what you should do is to attack the cause. No noble Lords—whether those who sit upon the Government Front Bench or those who sit anywhere else—are suggesting that they are going to dictate to the population their method of diet to that extent and are going to eliminate the real causes of this trouble. That is my reply to the statement that this is not a measure of mass medication but is merely the restoration to the diet of something which is missing from it. That is certainly not the case, because it is well known that it is extremely exceptional for natural water supplies to contain even as much as one part per million of fluorine. Therefore, it is quite clear that so much fluorine is not a natural constituent of human diets. I submit, with all respect, that it is entirely misleading to say that this is restoring to the diet something which has been lost out of it—far from it.

Now let me refer to what the noble Lord, Lord Webb-Johnson, said. I hope I have not cast any aspersion upon the medical profession in anything I have said. I do not doubt for a moment that they are earnest and pious men. But the noble Lord himself could no doubt give many illustrations of beliefs which were firmly held by members of the medical profession in times gone by but which have been abandoned and are now thrown upon the scrap heap. The fact that they were earnestly and piously held is not necessarily a proof that they were true; and what we ought to seek in all these things is the truth. So far as chalk in bread is concerned, I am not greatly worried about it, because I think in all probability it is quite innocuous. I doubt whether it does any great amount of good—I do not know that there is any proof that it does—but, at any rate, I think it is relatively harmless, and, therefore, I am not so much worried about it. But when it comes to iodine, which is proposed to be introduced specifically in order to prevent goitre, which is an iodine-deficiency disease, we are coming on to a somewhat different ground, especially in this country. Observe that the term "endemic goitre" is used in the report of the Medical Research Council. Goitre is not endemic in every part of this country. It is confined, as the word "endemic" means, to certain localities where it may be true that there is a deficiency of iodine in the water supply or in the soil. In such cases it may be quite proper to remedy a deficiency of something which, generally speaking, is to be found in the diet but which may be absent in some particular place.

Even there I have the greatest hesitation in saying that we should force such things upon people willy nilly. I would hesitate very much about that. And when it comes to a case such as fluorine then, indeed, the arguments become, so I think at any rate, overwhelmingly strong, because in the first place it simply has not been proved that fluorine is innocuous. On the contrary, there is a great deal of evidence to show that when it is taken in small quantities for long periods it can produce serious ill effects. The danger of this, which I endeavoured to point out when I opened the debate, is that attention has been concentrated upon one aspect of this subject only—namely, that it appears to produce a greater immunity to dental decay in the teeth of our children if it is administered to them during the period of growth. But in all the experiments which have been made so far, there is no conclusive evidence that that benefit continues indefinitely.

Only last August there was an article by Mr. Charles Dillon in the Dental Practitioner in which he referred to the case of South Shields, which is always brought up in this connection as a place where there is something approaching one part per million of fluorine in the water supply. He compared it with the case of Ipswich. where there is a very small fraction of fluorine in the water supply, and he presents in this article a little graph which shows that in the earlier decades of life it is indeed true that the incidence of dental decay in South Shields is lower, but in the later decades of life it shoots up and exceeds that in Ipswich. That is just one illustration, and among other things it shows that unless there has been a carefully regulated experimentation which is capable of removing all the extrinsic factors which may apply—and, as I have said, it is well known that the condition of teeth depends upon diet generally—and unless that experimentation has been so accurate and so complete as to eliminate all the other factors and to find out what the ultimate result of this one is, then there is no adequate basis even for the first part of the theory.

So far as the effects of the use of fluorides upon human beings of all ages and during the whole course of life are concerned, there has been no experimentation at all, nor, so far, has there been adequate equivalent experimentation upon test animals in this country or in the United States. But we do have the evidence which I quoted from Professor Steyn—that fluorosis is a serious problem in the Union of South Africa. It is definite and clear that this is a dangerous substance which produces ill effects; and, therefore, on that aspect of the case it seems to me that it would be most unfortunate if the Government of this country were to persist in the plan of making a mass experiment upon the citizens of some particular locality.

Lord Carrington, in his reply, dealt with the question of principle which underlies all this. It is perfectly true that in public affairs it is often necessary that one should try to balance up as evenly as possible all the many considerations of principle which can arise with regard to some particular course of conduct. The decision or judgment upon questions of that kind is undoubtedly a very difficult matter; it is the test of statesmanship. But I do not accept the principle that the only consideration which arises in cases such as we are discussing to-day is the health of consumers. I do not agree that the Government have an unlimited right to compel people to consume certain things or to read certain things or to do certain things without any freedom of choice being left to the individual at all.

Lord Hankey said, and very truly, no doubt, that in time of war many things had to be done to which in normal times we should not have consented. Salus populi suprema lex—but that is not the test which ought to be applied in these cases. It ought still to be open to people to eat what they want, by all means, let the Government give them advice. I would go further than that and say, as I have said in connection with the Food and Drugs Amendment Bill, that the. State has a right to prevent the introduction into the diet, for commercial purposes, of poisonous substances which are riot natural articles of food. But, conversely, I say that it is equally wrong for the State to insist upon the introduction in to a food of substances which are not natural articles of diet—at least in the quantities proposed—and to force them upon everybody. Why do these particular cases arise—chalk in bread, iodine in salt, and fluorides in water supplies? It is because the consumer will net know what has been done. The chalk in the bread is tasteless; the iodine in the salt is masked by the taste of salt, and the fluorides are tasteless and colourless. Therefore, you can inflict them on the population without exciting a revolt—and they certainly would revolt if you endeavoured to control other articles of food and compelled them to take these.

It is not, of course, my intention to carry this Motion to Division. I have no doubt that the Government, if they wanted to, could easily defeat the Motion, but I do not want them to be put in the position of having voted, against it, for I think the principle which underlies it is so important that it deserves the serious consideration of all of us; and it would be a very great pity for anyone to vote against it. Therefore. I have pleasure in asking leave to withdraw my Motion.

Motion for Papers, by leave, withdrawn.

House adjourned at four minutes past five o'clock.