BMJ 1999;319:807-811 ( 25 September )

Papers

Disturbance of cerebral function in people exposed to drinking water contaminated with aluminium sulphate: retrospective study of the Camelford water incident

Paul Altmann, consultant nephrologist, a John Cunningham, consultant nephrologist and physician, b Usha Dhanesha, principal optometrist, c Margaret Ballard, consultant clinical psychologist, d James Thompson, senior lecturer in psychology, e Frank Marsh, consultant nephrologist and physician. b

a Oxford Kidney Unit, Oxford Radcliffe Hospital, Oxford OX3 7LJ, b The Royal London Hospital, Whitechapel, London E1 1BB, c Paybody Eye Unit, Coventry and Warwickshire Hospital, Coventry CV1 4FH, d Priory Hospital, Roehampton, London SW15 5JJ, e University College London Medical School, London W1N 8AA

Correspondence to: P Altmann paul.altmann{at}orh.anglox.nhs.uk

Objective: To establish whether people exposed to drinking water contaminated with 20 tonnes of aluminium sulphate in the Camelford area of Cornwall in the south west of England in July 1988 had suffered organic brain damage as opposed to psychological trauma only.
Design: Retrospective study of affected people.
Participants: 55 affected people and 15 siblings nearest in age to one of the group but who had not been exposed to the contaminated water were studied.
Main outcome measures: Various clinical and psychological tests to determine medical condition and anxiety levels in affected people. Assessment of premorbid IQ (pFSIQ) with the national adult reading test, a computerised battery of psychomotor testing, and measurement of the difference in latencies between the flash and pattern visual evoked potentials in all participants.
Results: The mean (SE) pFSIQ was above average at 114.4 (1.1). The most sensitive of the psychomotor tests for organic brain disease was the symbol digit coding (SDC) test (normal score 100, abnormal <85). Participants performed less well on this test (54.5 (6.0)) than expected from their pFSIQ (P<0.0001) and a little less poorly on the averaged less discriminating tests within the battery (86.1 (2.5), P<0.0001). In a comparison with the 15 sibling pairs (affected people's age 41.0 (3.3) years v sibling age of 42.7 (3.1) years (P=0.36) the exposed people had similar pFSIQ (114.7 (2.1)) to their siblings (116.3 (2.1), (P=0.59) but performed badly on the symbol digit coding test (51.8 (16.6)) v (87.5 (4.9) for siblings, P=0.03). The flash-pattern differences in exposed people were greater than in 42 unrelated control subjects of similar age (27.33 (1.64) ms v 18.57 (1.47) ms, P=0.0002). The 15 unexposed siblings had significantly better flash-pattern differences than their affected siblings (13.4 (2.4) ms v 29.6 (2.9) ms, P=0.0002). No effect of anxiety could be shown on these measurements from the analysis of the anxiety scores of exposed people.
Conclusion: People who were exposed to the contaminated water at Camelford suffered considerable damage to cerebral function, which was not related to anxiety. Follow up studies would be required to determine the longer term prognosis for affected individuals.


Key messages

  • Aluminium is a well established neurotoxin

  • Accidental contamination of drinking water in Camelford by aluminium sulphate led to symptoms of loss of concentration and short term memory that were initially attributed to anxiety

  • In residents exposed to the contaminated water psychomotor performance was poorer than predicted from premorbid IQ and the difference between flash-pattern visual evoked potentials was greater than normal

  • Anxiety did not influence either of these measures of cerebral function

  • Aluminium sulphate poisoning probably led to long term cerebral impairment in some people in Camelford




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Rapid Responses:

Read all Rapid Responses

ALUMINIUM POISONING
Neil D Burman
bmj.com, 6 Oct 1999 [Full text]
Cerebral Dysfunction, in Camelford: inappropriate study, inapprop riate conclusions
Murray Virginia
bmj.com, 28 Oct 1999 [Full text]
Study has several methodological shortcomings
Theodore I Lidsky
bmj.com, 13 Dec 1999 [Full text]
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