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LUORIDATION is the addition of fluoride ion to a water supply so that the fluoride concentration reaches the optimum level to prevent a substantial degree of dental caries without leading to dental fluorosis. This optimum level usually ranges from 0.7 to i.o ppm, de040sce.' pending on climate; it could be even lower in some very hot climates. Fluoride is also used as a dietary supplement, as a therapeutic mouthrinse, in professionally-applied treatment in the dental office, and in toothpastes. This paper presents the epidemiological basis for fluoridation of water supplies and examines some of the political aspects of fluoridation. The scientific basis for alternative uses of fluoride will also be briefly examined and some policy suggestions made regarding the promotion offluoridation.

c*# N August 15, 1985 a fire swept through an electroplating plant in Queens, New York. As a precaution against i~ 2cyanide fumes, hundreds of area residents were evacuated from their homes. Firefighters were able to prevent a e c) catastrophic release of deadly fumes because they used k*4s5 carbon dioxide extinguishers rather than water in a storage area containing drums of metal cyanide solutions. Fortunately, fire officials knew what was in the drums and that the cyanide would react with water to form cyanide gas (1). Too many of the stories, however, have unhappy endings. A study conducted for the Environmental Protection Agency (EPA) revealed that at least 6,928 accidents involving toxic chemicals have occurred in the United States in the last five years. More than 135 people died as a result, and 1,500 were injured. The releases resulted primarily from large and small facilities involved in the production and storage of chemicals. These figures underestimate the real toll. Not all of the available data bases were used (2). Secondly, deaths and injuries associated with long-term exposure are not considered in the study. More information in the hands of the public, workers, the government and the companies themselves may have prevented many of the casualties. The need for better information is highlighted by recent findings that

(96) Ray E. Trussell, Jack Elinson, and Morton L. Levin, "Comparison of Various Methods of Estimating the Prevalence of Chronic Disease in a Community," American Journal of Public Health, 46 (February, 1956), 173-182. (97) Urban Life Research Institute, Nursing Services in a Large Urban Hospital, New Orleans: Tulane University, 1954. (98) L. Wes Wager, "The Measurement of the Job Satisfaction of Professional Nurses," Research Studies of the State College of Washington, 20 (June, 1952), 45-55.

To the Editor:— In the March issue of the American Journal of Public Health there appeared an article entitled "The Expanding Scope of Public Health Laboratories," outlining a plan developed in Montgomery County, N. Y., whereby "an approved county laboratory, supported entirely by state and county funds, provides as a free public service for a population of 70,000 people not only the usual diagnostic and sanitary services but also all the medical tests which in most other communities are the task of hospital and private pathological laboratories. This includes all autopsies, surgical pathology, hematology, serology, blood grouping, urinalysis, chemistry of blood and other body fluids, bacteriology, bacterial and agglutination tests, preparation of bacterial vaccines, gastric analysis, basal metabolism, examination of feces and exudates." In the article the plan is commended on the basis (1) that the centralization of all types of medical and public health laboratory work in one organization

The report of one or several "new" stains for diphtheria bacilli almost every year since 1895 would seem to indicate that none of those previously recommended have been entirely satisfactory. I have tried practically every stain heretofore described. A rather critical review of these will appear before long in the American Journal of Public Health . My purpose here is to make available the formula for a new method of staining diphtheria bacilli which I have developed and which my associates and I have found to be more satisfactory than any stain heretofore described. Two solutions are used: Solution 2 is the same as the iodin solution used in the Gram stain: TECHNIC OF STAINING Smears are made on slides or cover glasses in the usual manner, fixed by heat, and stained with toluidin blue solution for five minutes. The stain is then drained off without washing, and the iodin solution

Pope, C. R., S. S. Yoshioka and M. R. Greenlick. 1971 "Determinants of medical care utilization: The use of the telephone for reporting symptoms." Journal of Health and Social Behavior 12 (June) :155162. Rein, M. 1969 "Social class and the health service." New Society 14 (November 20) :807810. Rosenstock, I. M. 1966 "Why people use health services." Milbank Memorial Fund Quarterly 44 (July) :94-124. Solon, J. A. 1966 "Patterns of medical care: Sociocultural variations among a hospital's outpatients." American Journal of Public Health 56 (June):884-894.

MEALS ON WHEELS programs provide a means of delivering meals on a regular basis to people who are unable to leave their homes or whose physical conditions or home environment would otherwise preclude the preparation of meals which meet their specific normal or therapeutic nutritional needs. Although still in the developmental stage, this individualized service is designed to help the recipient maintain or restore his health, to hasten recuperation during convalescence, and to enable him to attain the highest possible level of independence without unnecessary institutionalization. The Public Health Service's Division of Chronic Diseases fosters the development of meals on wheels services as a part of or in conjunction with out-of-hospital programs for the chronically ill and aged. To provide baseline data to professional personnel of home care programs, the division conducted a limited study of programs known to be operating in 1962. The findings: reveal useful information, not previously available, on the characteristics of existing portable-meals programs and indicate the possibility that the type of person receiving the service is in need of additional health services in the home. Data from the survey emphasized the need for a depth study of home-delivered meals services, and this is being done by the National Council of Aging under a special grant from the Community Health Services and Facilities Act of the Public Health Service. The report will be available as a supplement to the May 1965 issue of the American Journal of Public Health. In the first linited survey, questionnaires were sent to 25 known programs. Each organization was requested to complete two sets of forms if possible. The first form described program activities and administration, and the second form was an individual report of persons served by meals on wheels in the latter half of 1962. Twenty-two programs submitted the activity form; two programs were found to be inoperative, and one program did not respond. Sixteen programs submitted individual forms for a total of 439 persons. The persons served by the 6 programs which did not submit this form represented approximately 20 percent of all the patients receiving services in the 22 programs.