Captain Webb’s legacy: the perils of swimming the English ChannelBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7372 (Published 16 December 2014) Cite this as: BMJ 2014;349:g7372
All rapid responses
We read Klemperer and Thomas's article on the Perils of Swimming the English Channel  with interest. Every year there are deaths from unexpected causes in otherwise fit and healthy open water endurance swimmers; for example we know of one case where acute bowel ischaemia was cited, with drowning, as the cause of death.
Acute bowel ischaemia has been noted in other endurance athletes particularly runners, and also in divers. It has been suggested that routine use of NSAIDs, and hypertonic sports gels and drinks, might be implicated in this and other causes of sudden cardiac arrhythmia in endurance athletes. When the additional physiological stresses of cold water are considered, is there is potentially an enhanced risk for swimmers?
As yet there is no clear understanding as to why these events happen. It would therefore be beneficial to collate a database of all deaths in open water swimmers from Coroners’ Reports. It is now possible for organisations such as the Royal Society for the Prevention of Accidents to request this information. This would provide valuable data that may help prevent further deaths.
While the health benefits of swimming outweigh the risks, the the rapid increase in participation in open water and cold water swimming  suggests an urgent need for research into the causes of these unexpected deaths, some of which might be avoidable. In so doing we can help to make the sport even safer.
Lynne Roper BA (hons) Dip Paramedic Science
Dr Mark Harper Bsc MBBS FRCA
Outdoor Swimming Society
 Klemperer F, Thomas ES. Captain Webb’s legacy: the perils of swimming the English Channel2014 2014-12-16 19:31:05.
 Dowling K. Britain warms to the freezing swim. Sunday Times. 2015 4 January 2015.
Competing interests: No competing interests
It was with considerable interest that I read the article on the perils of Channel swimming, but from my own personal experience of Channel swimming and long distance swimming, I do feel that there are several omissions and erroneous assumptions. Whilst I do not have a medical background and can only apologize for my presumptuousness, I do feel that with my experience I have something constructive to contribute to the debate.
To start with, the accompanying video implies that the Serpentine is the main training area for prospective Channel swimmers and that of course is erroneous. It may be true for Londoners with those aspirations, but there is extensive preparation which takes place in the Northern lakes and around the coast of Britain. Indeed, my home town of Weymouth produced five between 1951 and 1980, and there have been numerous others since. Whilst this may seem unimportant initially there are two relevant issues:-
• Whilst pollution is less of a problem than it used to be, it is still an issue, especially in fresh water, where the explosion in the rat population has led to a growth in associated diseases. This was recently demonstrated by David Walliams’ swim down the Thames when he suffered a number of intestinal problems
• Given the different densities of sea and fresh water it is inevitable that the body will float at different levels. Whilst at first that might seem insignificant, it can be enough to affect the breathing trough of front crawl swimmers which can lead to a change of head position and to excessive chafing, stubble erosion (See below), or salt water ingestion with its associated problems including sea-sickness.
Chafing can be a particular problem between the thighs, in the armpits and in the creases at the back of the neck. The traditional way of dealing with the
problem is to grease the areas to be affected in order to reduce friction. However, on a particularly long swim, chafing can still take place. The after-effects can be very uncomfortable and last for several days.
Stubble erosion is a problem restricted to mature male swimmers (I think!) No matter how closely you shave, the growth of stubble over a several hours long swim is inevitable. For some swimmers with the continual turning of the head to breath and the chin rubbing against the shoulder, the skin can be worn away; this happened to me on several occasions; it was painful and the after-effects long lasting. Prevention being better than cure, layers of plastic skin were built up beforehand and covered in Vaseline; this could delay the effects but was not entirely fool-proof.
The act of ‘greasing up’ was mentioned in relation to its aid in keeping the swimmer warm and the actual limited value: quite right! It does have limited value in lubricating potential chafing areas and more important, preventing sunburn (See below). The reality is, it actually washes off in a very short time. The evidence is in a ‘Look at Life’ documentary made by the Rank Organization Crossing the Channel. It shows me being liberally coated in lanolin before the swim but after several hours there is little evidence of it. In fact, it has had detrimental effects; more than one swimmer has had to give up after ingesting lanolin whilst feeding and becoming sick; and on another occasion a swimmer had to be pulled from the water when a shoal of mackerel attacked him for the grease he was wearing.
A major omission is the problem of sunburn. Very severe sunburn can be the result of a prolonged swim in sunny conditions, and because of refraction in the water the whole of the body is affected, the exception being where the swimming costume and goggles are worn. Being fair skinned, I suffered particularly and as a result am living with legacy of a number growths and a malignant melanoma.
Gregory Schofield M.A. / England to France 1964
Competing interests: No competing interests