1062 S.A. MEDICAL JOURNAL 11 December 1954 morrhage (from dilated veins) was severe and 6 of the patients died. Alcoholic cirrhosis was about 5 times as common as in the English series quoted above. 1 The fact that alcoholic cirrhosis was found exclusively in the European group, while the Cape Coloured patients did not present a single case, was rather sur- prising. Brock 5 drew attention to the fact that 'regis- tered' deaths from cirrhosis of the liver at the Cape are more common amongst Europeans than the Cape Coloured; Hansen 6 in a study of the hospital and autopsy records of the Groote Schuur Hospital came to the same conclusion. This present series is very small, but it appears to confirm this finding. It is difficult to explain this disproportion, especially when it is con- sidered that malnutrition and alcoholism are common among the Cape Coloured, and that the cirrhosis rate among the Bantu Africans is high. A possible explanation is that the European who indulges in alcohol generally drinks spirits, usually brandy, while the Coloured man drinks Cape wine. The European is usually a steady drinker, while the Cape Coloured is often a week-end drinker only. - Alcohol also seemed to be the immediate cause of provoking a haemorrhage in 4 cases of gastric ulcer, 1 case of duodenal ulcer and 3 cases in the mild- haemorrhage group. Taken together with the cases of alcoholic cirrhosis, there were 16 cases, with 18 ad- missions, in a total of 142 episodes of bleeding; thus in 13 % of cases of haemorrhage, alcohol played an im- portant role in causation. Prevention of Haemorrhage Severe gastro-intestinal haemorrhage is always a most serious emergency. Close, constant attention and great resources are necessary for its adequate management. This grave complication might be avoided by early recognition and treatment of peptic-ulcer cases and a full appreciation of the other factors which lead to severe haemorrhage. I am indebted to the members of my staff at the Groote Schuur Hospital for their valuable co-operation; also to Mr. G. Sacks, members of his surgical firm, and Mr. T. Schrire. I appreciate help given by Dr. R. Tobias, Dr. J. Gant and Dr. D. Krikler. REFERENCES I. Avery Jones, F. (1947): Brit. Med. J., 2, 441 and 477. 2. Meulengracht, E. (1935): Lancet, 2, 1220. 3. Gunz, F. W., Gebbie, I. D. and Dick, R. C. S. (1954): Brit. Med. J., 1, 950. 4. Crohn, B. B. and Janowitz, H. D. (1951): Gastroenterology, 19,605. 5. Brock, J. F. (1949): S. Afr. Med. J., 23, 1000. 6. Hansen, J. D. L. (1952): Ibid., 26, 441. 'SWIMMER'S ITCH' IN SOUTH AFRICA BOTHA DE MEILLON and N. STOFFBERG South African Institute for Medical Research and Council for Scientific and Industrial Research, Bilharzia Natural History Unit, Johannesburg 'Swimmer's itch', 'cercarial dermatitis', 'schistosome itch' and 'water rash' are all names for a rash produced in human beings by the cercariae of non-human schisto- somes. It is true that under certain circumstances the cercariae of the human parasites may also produce a dermatitis as a result of skin penetration but this is not included under 'swimmer's itch' and is probably best referred to as 'bilharzial rash' or 'itch'. 'Swimmer's itch', though well known from the United States, Canada, Europe, Asia, Australia and ew Zealand, has not been recorded from Africa (Cort 1950). We feel sure that once attention has been drawn to its occurrence here it will be found to be fairly common. The present communication deals with one case in which a tentative diagnosis of 'swimmer's itch' was made, and the production of classical lesions in 3 volunteers with non-human cercariae from the locality near Johan- nesburg where the patient bathed. The Presumed Case of 'Swimmer's Itch' Through Dr. E. D. Arkell of Swaziland there was referred to us a small boy (LT.) aged 10 years who, after bathing in a swampy pool at Van Wyksrust, about 15 miles south of Johannesburg, developed a severe rash. He had swum in the same pool a week previously and had not noticed any skin irritation. The rash and intense itching persisted for about 3 days, when it subsided. According to the father of the boy the patient showed no other symptoms nor did he, at any time, complain of any systemic or other disturbances. The area where the infection occurred is known to be free of human bilharziasis and our surveys have shown that none of the accepted vectors of S. haematobium or S. mansoni occurred there. Experimental Several visits were made to the swampy pool in which the patient had swum. On each occasion hundreds of Lymnaea natalensis and Bulinus tropicus were collected. They were found to be shedding at least 6 different types of cercariae. Amongst them were 4 species of fork-tailed cercariae and with these we performed some experiments in mice and monkeys. one of them produced a derma- titis when applied to the skin of monkeys. These experiments have not been concluded and it is hoped
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