The cases to be described here occurred in the Aden Protectorate where for the last 12 years mass screening of the chest to exclude pulmonary tuberculosis has been carried out. The patients had all drunk the brackish water from the wells, and the analysis of the water from a well which was the source of water for six of the cases showed sodium fluoride to be present in six parts per million. . . .

Anaemia

Many of the patients exhibit a degree of anaemia, but unfortunately not many of the patients in this series were examined for the presence of anaemia.

The problem of anaemia among these patients is a difficult one as there are often signs of malnutrition and other diseases which could be responsible for it.

Albuminuria

Of the 19 patients in the series, 12 were examined for the presence of albuminuria, and this was found to be present in 11. The urinary excretion of fluorine damages the kidney, which results in the common finding of albuminuria.

Backache

This is a common complaint and is usually proportional to the degree of calcification of the spinous, ilio-lumbar and sacro-iliac ligaments and can closely simulate ankylosing spondylitis. . . .

The pelvis is the commonest site of muscular attachment thickening, especially on the surfaces of the pelvic and ischeal bones.

The cortical thickening can be very extensive and profuse and lead to very marked irregularity of the bone surfaces. It is usually best seen in the femur and tibia.

The ligamentous calcification  is often periarticular and shows as osteoarthritis of the spine and hip joints as well as of the sacro-iliac joints (Fig. 4).

Vascular calcification

It has been found in this series that five of the 19 patients had vascular calcification. This took the form of the ladder type of pattern in the leg vessels, usually associated with Monckeberg type of change rather than of the athero-sclerotic appearance of parallel lines of calcification. The one exception was a patient aged 38 who had calcification of the aortic arch. . . .

The incidence of vascular calcification seems too high to be coincidental, and further investigation may confirm that this is another complication of the disease. Some of the films examined have not been of the best quality owing to the difficulties of correct processing under tropical conditions, and three other patients showed possible evidence of calcified arteries, but have not been included in the number quoted owing to the poor quality of some of the radiographs.

The ages of patients with vascular calcification ranged from 35 to 50. The patient aged 35 had very extensive and obvious calcification, and it was also obvious in the others. The patter of the calcification suggests median sclerosis such as occurs in Monckeberg’s sclerosis.