Endemic fluorosis with neurological complications in a Hampshire man

Abstract

Only a few comparatively minor bone changes attributed to naturally occurring fluorine in water supplies have been reported in Britain, and in a recent review Doig (1963) concluded that endemic fluorosis is practically unknown in Britain, except for mottling of the teeth. Severe endemic skeletal fluorosis has, however, been reported from many other parts of the world. 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. CASE HISTORY G.K., a 57-year-old carpenter from Nursling near South-ampton, was admitted to the Royal South Hants Hospital on 1 April 1964 complaining of progressive weakness of the legs. In 1956 he fell 12 feet from a ladder, landing on his feet and buttocks, and noticed an immediate burning pain in both groins and back, with numbness and paraly-sis of both legs lasting about half an hour. He made a good recovery, and resumed work two weeks after the fall, but continued to notice pain and weakness of the left ankle, and occasional pain in the lumbar region. In February 1959 he was seen as an out-patient com-plaining of progressive stiffness of both legs for three months, with discomfort in the calves after walking for an hour. He had occasional flexor spasms, but noticed no sphincter disturbance. Examination showed limitation of movement of the right hip, reduction in power of all leg muscles, pathologically brisk knee and ankle jerks, bilateral extensor plantar responses with preservation of the abdominal and cremasteric reflexes, and absent vibration sense below both iliac crests with no other sensory loss. He was advised to come into hospital for further investigations, but did not do so. In November 1959 he saw an orthopoedic surgeon because of pain in the lower lumbar region radiating to