(C) Peter Meiers - http://www.fluoride-history.de
Gerald Judy Cox
Toxic effects have been attributed to aluminum compounds since they came in use e. g. as ingredients in baking powders (1). During the 1920´s aluminum cooking utensils too were suspected of posing a health hazard (2) and ALCOA installed a "Utensil Fellowship" at Mellon Institute (3) to investigate the problem. When the occurrence of "mottled teeth" was observed among the inhabitants of a small bauxite mining community, Bauxite, Arkansas, chemists at the Aluminum Company of America (ALCOA) hypothesized that aluminum (contained as the oxide in the bauxite ore) might interfere with the metabolism of lime and phosphorus and thus cause or contribute to the dystrophy. Dr. Gerald Cox was hired to the "Utensil Fellowship" to investigate this possibility. His results, reported in April 1931 at the annual meeting of the American Society of Biological Chemists (4), but known to ALCOA much earlier (5), were interpreted by ALCOA´s research chemist Francis Frary to show what had been expected: "An excess of soluble salts of either iron or aluminum will eliminate this phosphorus, combining with the phosphorus in the foods to form insoluble phosphates, which are excreted. It would therefore appear rather probable that the presence of large amounts of aluminum salts in drinking water might be connected with the difficulties you mentioned" (5). But that was the wrong track, as Luther Branting, Superintendent, Republic Mining and Manufacturing Co., Bauxite, suggested in his reply to Frary: "As to the particular well water which was causing the damage, this water was from the deep wells and not from the ordinary shallow wells in this section. The water from the ordinary shallow wells even though the well be sunk in bauxite, seems to have no bad effects. Bauxite children who had used spring water or ordinary shallow-well water instead of the deep-well water have good teeth" (6). A spectrographic analysis of the suspected water was carried out at ALCOA´s Laboratory in New Kensington and surprisingly revealed the presence of fluoride (7).
In 1930, the world economic crisis contributed to a decrease in the per capita sugar consumption (8). Late in that year Edward Ray Weidlein, director of the Mellon Institute, announced the beginning of a broad investigation into possible industrial uses for raw and refined sugar. The comprehensive program, sustained by the Sugar Institute of New York, an organization representing the cane sugar refiners of the United States, would be supervised by George D. Beal and Gerald J. Cox. "Four chemists, headed by Dr. Cox, have begun the initial scientific research of the industrial fellowship" (9). At its conclusion in 1935, the use of sugar for conversion into several new chemicals had been developed and patented by Cox (10-12), the Niacet Chemicals Corporation made and marketed the cane sugar derivatives. "Mellon Institute effected these commercial arrangements with the hearty approval of The Sugar Institute, when that organization of producers of sucrose decided it did not wish to embark in the manufacture of chemicals" (3).
They have a saying in the institute that "once a fellow, always a fellow" (3). "By it is meant that we do not lose interest in the former incumbents of fellowships when they enter their donors´ or other companies´ organizations, nor do we lose interest in former donors. The former fellows and donors of the institute have proved to be our friends."
The outcome of the Nutrition fellowship reminds somehow of the "once a fellow, always a fellow" saying. Still on the sugar fellowship, Gerald J. Cox and Mary L. Dodds (both holders of the sugar chemicals patents) "attained in 1934 results that suggest the existence of a factor which, if present in the diet during a critical period of tooth formation, will aid in the construction of teeth resistant to decay" (13). Research on this mysterious "factor" -which everyone in the sugar business would dream of- was then "continued along broad lines, as a pure science investigation, through a grant from the Buhl Foundation of Pittsburgh" (3). The Journal of the American Dental Association added that "this new fellowship will have the advisory aid of L. H. Cretcher" (14), - another sugar specialist of the Mellon Institute (15). At the IADR meeting at Baltimore, March 13-14, 1937, - a very interesting meeting from several points of view- Cox reported that in rats the diet of the mother during pregnancy and lactation influences the caries susceptibility of the young. "Increased haliver oil, increased Ca and P, high fat diet, or meat diet to mothers caused increased immunity to corn-meal caries in offspring" (16) - which means, any diet low in carbohydrate would probably have the same effect.
What then led Cox to become interested in fluoride?
"This fact suggested to us that the diet during pregnancy and lactation or, in other words, the diet during the period of the formation of the permanent molar enamel of the young rats, influenced subsequent susceptibility to corn meal caries. We accordingly set up a series of experiments to test the effect of various food factors in conferring relative resistance to caries in young rats" (17). Such studies provided another splendid opportunity for combination with a project other Mellon Institute researchers were working on. "The fellowship system of industrial research at the Mellon Institute provided the accident that we were adjacent to the laboratory where studies of industrial uses for XXX liquor were under way" and so, among other substances tested, Cox and his crew supplemented the diet of mothers during pregnancy and lactation with 0.5 gm of XXX liquor (17). XXX Liquor, the "trade waste of the milk industry", Cox claimed in 1939, was found to be "sufficiently concentrated to be saturated with fluoride from the original milk" (18). In 1941 he explained: "This is a product of the Borden Company obtained as a residue, when all other useful products have been removed from milk" (17). Milk usually has no high fluoride content, but this "XXX liquor" (19, 20) may have contained it, purposely added as specified in a patent granted to the Borden Company (21), claiming "- dry skim milk free from strong alkali and having substantially all of the calcium thereof chemically separated" either as calcium fluoride by addition of soluble fluorides or hydrogen fluoride, or as an oxalate or metaphosphate.
Yet, fluorine around that time had a bad image as the cause of mottled teeth. The public perception of the problem thus had to be addressed and reversed somehow.
"Mothers fed the supplement of XXX liquor bore young with very high resistance to corn meal caries. In April, 1936, at the Washington meeting of the American Institute of Nutrition, George R. Sharpless gave a paper indicating that the addition of aluminum salts to the diet of the rat in which fluoride was present prevented the formation of mottled incisors in rats. This suggested to us that XXX liquor contained aluminum salts, which were preventing the deleterious action of fluorine. Consequently we set up an experiment to produce teeth which were quite susceptible to decay because of the high fluorine content in the mother´s diet during pregnancy and lactation. It was then our intention to add aluminum salts to the diet to prevent the bad effects of fluorine. However, the results of this preliminary experiment were the most resistant teeth that we had observed at that time. ... It cannot be said that we sought such results; they came to us in an experiment designed to prove exactly the opposite of what we observed" (17). Cox´s reasonings sound somewhat strange, and his data on caries incidence in the rats fed fluoride -in experiments carried out late in 1936 (17, 18) - were anything but convincing proof of a reduction.
Referring to the work of Dean et al. as well as Armstrong and Brekhus, and his own inconclusive experiments in rats (!), Cox suggested in 1939 that "the case should be regarded as proved" (22) and that the "present trend toward complete removal of fluorine from water and food may need some reversal" (23). "Concordant evidence from 3 different approaches, with no adverse data, should be such sufficient proof of the value of fluorine in the prevention of dental caries that means of control of this element in the whole dietary of children should be undertaken. Control of the fluorine content of community water supplies, in most cases by addition of fluorides, provides an attractive means of mass reduction in dental caries, but prophylactic measures through other media, such as bottled waters, milk supply or the judicious use of fluoride-containing medicinals, are feasible" (18). "Furthermore, the prophylaxis could be applied in such a way that the individual would be hard put to escape the treatment" (23).
Director of Dental Research
In 1948, the same year that Trendley Dean of the USPHS was appointed director of the newly organized National Institute of Dental Research, Cox was appointed director of dental research in the School of Dentistry, University of Pittsburgh (23a). In this position Cox did not only receive grants from the Nutrition Foundation (24), Swift & Company (25) and Johnson & Johnson (26) but also, in 1970, the Chemical Pioneer Award of the American Institute of Chemists for "his part in the discovery and application of dietary fluoride in the prevention of dental caries. This was based on the formal proposal of fluoridation of water which was presented at the September 20, 1939, meeting of the Western Pennsylvania Section of the American Water Works Association held in Johnstown, Pa." (27)
(1) McCollum E.V., Orent-Keiles E., Day H. G.: "The newer knowledge of nutrition", New York 1939, pp. 275-278; (2) Bergman J.: "Aluminum: Satan´s metal and killer of millions? The Watchtower´s incredible crusade against aluminum", Dec. 1998; (3) Weidlein E.R.: "Various results of being researchful", Science 82 (Dec. 13, 1935) 553-562; (4) Cox G.J., Dodds M.L., Wigman H.B., Murphy F.J.: "The effects of high doses of aluminum and iron on phosphorus metabolism", J. Biol. Chem. 92 (1931) XI; (5) Francis C. Frary to L. R. Branting, Dec. 9, 1930, in the ALCOA papers, Wisconsin State Historical Society, Madison, Wisconsin; (6) L. R. Branting to Francis C. Frary, Dec. 12, 1930, ALCOA papers; (7) H. M. Laudemann to R. C. Cross, Jan. 6, 1931, ALCOA papers; (8) "Sugar consumption", Scientif. Amer. 145 (July 1931) 55; (9) Weidlein E. R., Science 72 (Dec. 26, 1930) 651; (10) Cox G. J., Ferguson J.H, assignors to Niacet Chemicals Corporation.: "Sugar Acylation", US Patent 2,013,034, filed June 22, 1932, patented Sept. 3, 1935; (11) Cox G. J., Dodds M. L., assignors to Niacet Chemicals Corporation: "Manufacture of esters of levulinic acid", US Patent 2,029,412, filed Dec. 19, 1934, patented Feb. 4, 1936; (12) Cox G. J., Dodds M. L., assignors to Niacet Chemicals Corporation: "Manufacture of calcium levulinate", US Patent 2,033,909, filed Dec. 19, 1934, patented March 17, 1936; (13) "Reports: Research at Mellon Institute during 1934-35", Science 81 (May 3, 1935) 436; (14) "New Research on Nutrition at Mellon Institute", JADA 22 (1935) 1084; (15) "Investigate Industrial Uses for Sugar", Scientif. Amer. 145 (Aug. 1931) 128-129; (16) Cox G. J.: "System of study of experimental dental caries as related to nutrition" (Abstr), J. dent. Res. 16 (1937) 302; (17) Cox G. J., Matuschak Levin M.: "Resume of the fluorine - caries relationship", IN F. R. Moulton (ed.) "Fluorine and Dental Health", AAAS Meeting, Dec. 12, 1941, Dallas, Texas, publ. Washington 1942, pp. 68-73; (18) Cox G. J., Matuschak M.C., Dixon S. F., Dodds M. L., Walker W. E.: "Experimental Dental Caries. IV. Fluorine and its relation to dental caries", J. dent. Res. 18 (1939) 481; (19) Ansbacher S., Flanagan G. E., Supplee G. C., assignors to The Borden Company, New York: "Concentration and isolation of water-soluble vitamins", US Patent 2,186,314, filed Feb. 1, 1936, patented Jan. 9, 1940; (20) Supplee G.C., Flanagan G. E., assignors to The Borden Company, New York: "Process of making vitamin- containing material", US Patent 2,006,699, filed Dec. 16, 1930, patented July 2, 1935; (21) Salzberg H. K., assignor to The Borden Company, New York: "Soluble dried solids of milk and method of producing the same", US Patent 2,181,003, filed Jan. 11, 1936, patented Nov. 21, 1939; (22) Cox G.J.: "Dental caries and domestic water supplies", J. Am. Med. Assn. 113 (1939) 1753; (23) Cox G. J.: "New knowledge of fluorine in relation to dental caries", J. Am. Water Works Assn. 31 (1939) 1926; (23a) J. Am. Dent. Assn. 37 (1948) 603; (24) "Nutrition Foundation grant to Pittsburgh Professor", J. Am. Dent. Assn. 40 (1950) 360 (Note: The Nutrition Foundation was organized in 1942 by 15 "Food" manufacturers, among them Coca-Cola Company, "to aid the food industry in appropriately solving the general and individual problems relating to that science (nutrition)" as announced in Science 95 (1942) pp. 64, 321 and 427; the Nutrition Foundation also publishes "Nutrition Reviews"); (25) "Nutrition and caries to be studied at Pittsburgh", J. Am. Dent. Assn. 41 (1950) 372 c; (26) "Research grants received by Pittsburgh Dental School", J. Am. Dent. Assn. 42 (1951) 91; (27) "Pittsburgh Professor earns chemists´ award", J. Am. Dent. Assn. 81 (July 1970) 65;