Swimming-Pool Elbow

When the 37-year-old woman who ran a pet shop in a Los Angeles suburb cut her right middle finger on the metal rim of a tropical-fish tank, she thought nothing of it. The cut seemed to be clean, and it healed quickly. But within a month, abscesses formed under the skin on the back of her finger and hand. They were not painful, but they were unsightly, and occasionally one of them burst and oozed a sticky fluid until a new scab formed. The woman's 18-year-old son cut his finger on the same tank, and soon he too had an abscess on his hand.

Dermatologists at Kaiser Foundation Hospital discovered that both mother and son had been infected with a microbe that is close kin to the bacillus of tuberculosis. Theirs were the first reported cases, say Dr. Sheldon Swift and Harold Cohen in the New England Journal of Medicine, in which a fish tank served as the incubator. The germ, undiscovered until the early 1950s, had previously been found nourishing only in swimming pools. There it has caused several outbreaks of what has usually been called simply sore elbow.

By far the biggest epidemic so far reported was in little (pop. 3,600) Glenwood Springs. Colo., which boasts a Texas-size pool: 650 ft. long, 110 ft. wide at the deep end. It was kept at a sybaritic 82DEG-85DEG by piping in water from a hot mineral spring. Trouble was, swimmers chafed their elbows on the pool's rough sides, and bacilli moved into the broken skin. There were at least 262 cases of "sore elbow" in the area. Doctors who tried antibiotics, anti-tuberculosis drugs, X ray, vitamins and plastic surgery did no better than nature. Most of the sores healed after a few months. But after they healed, 82% of the victims showed positive reactions to tests for tuberculosis even though virtually none of the children had had TB.

Because of its mineral content, the Glenwood Springs pool could not be chlorinated. (The chlorine reacted with the minerals to turn the water cloudy.) But now the pool has been rebuilt with tiled sides that are non-chafing and easier to disinfect.

Nobody knows how many cases of swimming-pool elbow or fish-tank finger may have gone undetected. "Swimming pools and fish tanks." says Dr. Swift, "constitute giant culture bowls--in both, water is being constantly recirculated and kept at certain temperatures that might happen to be suitable for the growth of the bacilli." Temperature seems to be a critical factor. In the laboratory, the bacilli grow poorly in a cool medium or at blood heat, do best at around 80DEG. That is in the temperature range of the exposed elbows and hands where they form abscesses--and of a heated pool or fish tank.

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