Fluoride Action Network


We describe below a case of skeletal fluorosis occurring in a Hampshire man who presented with neurological complications, and whose condition was appreciably improved by operation. We believe that this is the first case of its kind to be reported
from Britain, and also the first case of skeletal fluorosis with neurological involvement in which surgery has been attempted with benefit.

… FLUORIDE ANALYSIS The fluoride content of the patient’s blood, urine, and bone, together with that of two water samples, were estimated using thorium nitrate titration (Table). The two water samples contained negligible amounts of fluoride. The patient’s blood and urine contained normal amounts of fluoride, but the fluoride
content of bone was approximately twice the upper limit of normal. ·


Patient Normal Range
Blood (mg./100 ml.) <0·02 Traces (Roholm, 1937)
Urine (mg./100 ml.) <0·02 <0·37 (Sinclair, 1949)
Bone (mg./100 g. bone ash) 253 <130 (Roholm, 1937;
Zipkin et al., 1958)
Water sample 1 No detectable fluoride
Water sample 2 No detectable fluoride

… In Britain, Kemp, Murray, and Wilson (1942) reported an apparently high incidence of osteochondritis of the spine associated with dental fluorosis in children from the villages of Bampton and Launton in Oxfordshire, and from Malden in Essex. The well water used in the Oxfordshire villages contained only 0·3 to 1 ·2 p.p.m. fluoride, but Maiden’s water supply has the highest fluoride content in Britain (5 p.p.m.). A later more extensive study failed to confirm these observations (Eley, Kemp, Kerley, and Berry, 1957).

… Our patient spent his first 28 years of life at
Milford-on-Sea in Hampshire, during which time
he drank the mains water from the river Avon at
Christchurch (fluoride content 0·1 p.p.m.). From
1935 to 1940 (aged 28 to 33 years) he lived at Stratton
in Cornwall, where his drinking water came from the
river Tamar (fluoride content 0·04 p.p.m.). In 1940
he moved to Nursling near Southampton, and from
1940 to 1945 (aged 33 to 38 years) drank water from
a well in his garden. In 1945 his cottage was supplied
with mains water at low fluoride content, and the
well was bricked up. Permission to unblock this
well was refused, so we have been unable to analyse
this water. Water from a spring about a mile from
the cottage contained no detectable fluoride (water
sample 1 in Table). From 1946 to 1961 he worked at
the Lockerley War Department camp near Ramsey,
and in his work-time tea drank water from two
bores that are no longer in use. We were able to
obtain an unsatisfactory surface sample from one of
the bores which also contained no detectable fluoride
(water sample 2 in Table). The highest fluoride
content in any present public supply of water within
the county of Hampshire is 1 to 1 ·25 p.p.m. in a tiny
area on its northern fringe supplied by the Thames
Valley Water Board.

The following facts would appear to be relevant
to any attempt at determining the source and time
of our patient’s intoxication. Up to the age of 33
his drinking water was known to have a low fluoride
content. He first developed symptoms of fluorosis at
the age of 49, and was known to have radiographic
evidence of osteosclerosis at the age of 51. (Crippling
osteosclerosis usually appears some 10 to 20 years
after the ingestion of the fluoride.) At the age of 57,
fluoride estimations showed normal blood and
urinary levels, but a bone content about twice the
upper limit of normal, suggesting that the intoxication
had occurred many years previously, and
that it had ceased at least three years before the
estimations were made. In the light of these facts,
suspicion appears to rest on the cottage well that
supplied our patient with drinking water from 1940
to 1945, and it is unfortunate that all our efforts to
confirm this by analysing the necessary water sample
have proved unsuccessful.