1. Further evidence based on data on 52 cases tends to confirm previous observations that fluoride-containing drinking water in concentrations around 1 ppm accounts for a characteristic clinical syndrome. Its principal manifestations are: stiffness and pains in back; paresthesias and pain in legs and arms, especially the ulnar nerve area; evidence of gastritis, stomatitis and irritation of the mucous membranes in the lower intestinal and lower urinary tract; extreme malaise and mental deterioration; visual disturbances; brittle and breakable nails.
2. The evidence so far is based on: The identity of the symptoms observed with those described: a) in my first reported case from artificially fluoridated water; b) in industrial poisoning in men; c) in fluorosis encountered in natural fluoride areas; d) in animals grazing near plants emanating fluorides. Whereas there is an appreciable deterioration of general health, laboratory and objective findings are sparse at this stage of the disease. The cardinal features associated with advanced fluorosis, namely, changes in bones, ligaments, joints and teeth, were not noted in its incipient stage.
3. Further corroborating studies, now in progress, indicate that a variety of diseases of heretofore unknown origin, may be due to, or at least aggravated by, trace elements of fluorine in air, food and water.
4. The diagnostic criteria permitting the recognition of this syndrome in its incipient stage are discussed.