590

1. Summarised in The Lancet, 1959, ii, 78.

The preliminary phase of build-up ended duringFebruary, 1959, and since then there has been an averageof 16 residents or more. A mental hospital serving a catch-ment area of 360,000 population will probably only haveabout 16 patients at any one time suitable for and in needof a halfway hostel. Since August, 1958, we have tried tointerest other hospitals in the venture, but so far the num-ber of applicants has been small. This may be becauseeven though recovering patients have no homes, they haveroots in their native community and, however keen theymay be to leave hospital for a halfway house, they hesitateto go to a distant city and an unknown part of the country.

CONCLUSIONS

A halfway house for psychiatric patients capable of paidemployment is of value for a limited group of people. Thepatient who gains most seems to be the schizophrenicbetween 30 and 45 whose illness has passed the acutestage, who has lived for a number of years in a mental

hospital, and who is capable of regular work in the com-munity but not able to achieve an independent social life,either because he lacks interested relatives or initiative.

COMMITTEE ON ACCIDENT SERVICESIN a memorandum published a few months ago 1 the

British Orthopxdic Association set out the presentdeficiencies of hospital accident services in this countryand made a number of recommendations. A further

step towards improving this part of the work of theNational Health Service was announced this week. Onthe initiative of Mr. H. J. Seddon a conference on accidentservices was held in January at the Royal College of Sur-geons of England; and it set up a committee which is toexamine the situation and make proposals. The chairmanof the new committee is Mr. H. Osmond-Clarke, and thesponsoring bodies are the Royal College of Surgeons ofEngland, Edinburgh, and Ireland, the Royal College ofPhysicians of London, the College of General Practi-tioners, the British Medical Association, the British

Orthopaedic Association, the Society of British Neuro-logical Surgeons, the Society of Thoracic Surgeons ofGreat Britain and Ireland, and the British Association ofPlastic Surgeons. The committee’s recommendations arein due course to be passed to the Joint ConsultantsCommittee for discussion with the Ministry of Health.

MEDICAL LIBRARY FOR AUCKLANDFROM OUR NEW ZEALAND CORRESPONDENT

Sir Ernest Davis, of Auckland, has given 5::36,000 tobuild and partly maintain a medical library and meeting-rooms for professional purposes in the precincts of theAuckland Hospital. This will replace the central medicallibrary at present housed and almost wholly maintainedby the Auckland Hospital Board, the nucleus havingbeen formed many years ago by the late Dr. T. M.

Philson, a former medical superintendent.Sir Ernest’s gift is particularly welcome at the present

time. Medical research has begun in Auckland in thelast few years, and at some time in the future a medicalschool will be developed. The Committee on Univer-sities, under the chairmanship of Sir David HughesParry, lately suggested that the plan for the second medi-cal school and the proposed veterinary school should beshelved for ten years in view of the enormous arrears tobe made up in buildings, staffing conditions, &c., in the

university institutions. But persistent difficulties in

staffing the hospitals at the more junior levels, and otherfactors, may bring about a more urgent view.

1. Sunday Times, Jan. 10, 1960.2. Liverpool Daily Post, Jan. 28, 1960.3. Sunday Times, Jan. 17, 1960.4. Times, Feb. 10, 1960.5. Fluoridation: Errors and Omissions in Experimental Trials. By

PHILIP R. N. SUTTON, D.D.SC. London: Cambridge University Press.Melbourne: Melbourne University Press. 1959. Pp. 83. 8s. 6d.

6. Banus, J. Penguin Science News, 1955, 38, 27.7. Crichton-Browne, J. Lancet, 1892, ii, 6.8. Black, G. V., McKay, F. S. Dental Cosmos, 1916, 58, 129, 477, 627,

781, 894.9. McKay, F. S. ibid. 1929, 71, 747.

10. Bunting, R. ibid. 1928, 70, 1002.

Occasional Survey

FLUORIDATION:

THE PRESENT POSITION

THE new year began with a reawakening of the con-troversy over the fluoridation of water-supplies. Dr.Norman Parfit, medical officer of health for Abingdon,says in his annual report that any further delay influoridation is " quite inexcusable" 1; and he adds thatalthough the next two years should bring more positiveevidence (the fluoridation tests in Watford, Anglesey,and Kilmarnock end in 1961) " previous investigationshave amply demonstrated the good effects of fluorida-tion." Dr. Wynne Griffith, county medical officer forAnglesey, has also advocated the general adoption offluoridation, saying that " decay advances so fast that thechild is already a dental cripple when the school dentalsurgeon first sees him ",2 and that "fluoridation costsabout 6d. a head of the population for about a year. A verysmall price to pay for reducing the amount of decay by athird." 3 Now we read that the States of Jersey haverejected by a large majority a bill for the compulsoryfluoridation of water-supplies.4 These pronouncementscoincide with the appearance of a critical analysis bySutton 5 of the results of five of the recent fluoridationtrials in Canada and North America. His discussionrelates mainly to the statistical conduct of the trials, buta brief recapitulation of the story of the connectionbetween fluorides, enamel dysplasias, and resistance tocaries is necessary to provide the background againstwhich his work must be judged.As long ago as 1874, a Dr. Erhardt, of Emmerdingen,

described an experiment in which a dog’s molar tooth wasextracted, after which the dog was given small doses of potas-sium fluoride for four months. The opposite molar was thenremoved and was found to be harder and denser. Dr. Erhardtrecommended the sucking of one fluoride pastille a day for theprotection of the teeth against caries; according, to him such apractice had been known in England for several years, but noreference can be found in contemporary medical literaturebefore 1892.6 In that year Sir James Crichton-Browne statedthat a supply of fluoride was necessary when teeth were

developing. 7

The effects of excessive fluoride intake on dental enamelwere first noticed nearly sixty years ago among the inhabitantsof Naples, and, at about the same time but independently, bydentists in Colorado Springs. In 1908, the Colorado SpringsDental Society began a study of the " Colorado brown stain ".Much of the initial work was carried out by Black and McKay,whose first report was published in 1916.8 They did notcomment on any reduction in caries incidence, for their concernwas with the pathology of mottled enamel. After Black’s death,his work was continued by McKay, who reported in 1929 thatchildren with mottled enamel were less susceptible to cariesthan those with normal teeth.9 A similar observation had beenmade by Bunting in 1928 10 The connection with fluorine wasnot appreciated, however, until 1931 when Churchill analysedthe water of certain districts where mottled enamel was