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. ·

ANALYSIS OF FLUORIDE

	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.