Under the MicroscopeFinding something "hard to swallow" is a phrase usually used in a metaphorical sense, but there is also a literal sense and one example that we are all familiar with is sword-swallowing. I have seen this feat performed in the circus and also at street performances.
It looks extremely risky, but exactly how dangerous is it? Well, the answer is now to hand, published in the British Medical Journal, December 23rd, 2006, by Brian Witcombe, a consultant radiologist and Dan Meyer, executive director of Sword Swallowers' Association International (www.swordswallow.org).
Sword-swallowing originated prior to 2000 BC in India where it had religious significance. It is one of the oldest forms of performance art. It spread to China, Greece, Rome and then to Japan. During the Middle Ages it became a popular form of street theatre in Europe. However, with the founding of the Holy Inquisition in 1231, sword-swallowers, jugglers, magicians, prophets and other performers became the target of religious persecution, condemned as practitioners of the dark arts. Following the Inquisition, sword-swallowing enjoyed a resurgence in activity and the practice continues to the present day.
First, some rough anatomical details in order to understand where the swallowed sword goes. In simple terms, it goes down a tube that extends from your mouth to your stomach chamber. The tube is called the oesophagus and the upper part just behind the mouth is called the pharynx.
Most sword-swallowers perfect the technique only after many months of practice. The gag reflex must be desensitised by repeatedly putting fingers or other objects (spoons, plastic tubes, etc) down the throat. The performer, with neck hyperextended, must then learn to align the sword with the oesophagus and the pharynx. Force must not be used and the sword is usually lubricated, at least with saliva.
Physically, in medical terms, the blade goes into the mouth, the epiglottis (flap attached to root of tongue that prevents food from going into trachea and directs it into oesophagus) must be flipped open. The alignment and placement must be just right, so that the blade goes into the glottal chamber behind the voice box, through the pharynx, down the oesophagus, between the lungs, nudging aside the heart, past the liver and into the stomach to touch the bottom of the stomach at or near the duodenum. Each step must be done correctly and very precisely - one slightly wrong move and you could puncture any of those organs and kill yourself. Needless to say, I am not giving these anatomical details to encourage you to try this practice.
The introduction to Witcombe's and Meyer's paper begins with the magnificent understatement - "Sword-swallowers know their occupation is dangerous", but then informs us that the authors found only two English language case reports of sword-swallowing injury.
Incidentally, if you wish to join the Sword Swallowers' Association International (SSAI) you must be able to swallow a non-retractable solid steel blade at least two centimetres wide and 28cm long.
The authors sent letters to 110 members of SSAI in 16 countries, and 46 responded, consenting to information being published. Most were self-taught sword-swallowers and 40 of the 46 were men. The average height of respondents was 176cm and the average longest sword swallowed was 60cm. Twenty-five had swallowed more than one sword at a time, and one had swallowed 16 swords together. The record for the longest sword ever swallowed is said to be 82.5cm.
Nineteen respondents reported sore throats (should that be "sword throats"?) when they were learning to swallow, or after performing too frequently, or after using unusually shaped swords. Lower chest pain followed some performances but medical advice was rarely sought. Six suffered perforation of the pharynx or oesophagus. One had to have a bread knife removed transabdominally. Sixteen respondents reported intestinal bleeding, sometimes to the extent of requiring transfusion. The authors tell us: 'We excluded cases in which injury was related to swallowing items other than swords, such as glass, neon tubes, spear guns, or jack hammers."
No members of SSAI have died from sword swallowing, but deaths have been reported on the internet. A Canadian sword-swallower is reported to have died after swallowing an umbrella. The cost of medical care is a problem, with three members reporting medical bills ranging from €18,000 to €55,000.
Some sword-swallowing performers add embellishments to increase the danger and titillate the audience, eg performing under water, while lying on a bed of nails, or on a unicycle. Sometimes this can backfire seriously. The authors refer to one performer who lacerated his oesophagus after becoming distracted by a misbehaving macaw on his shoulder, and a belly dancing sword-swallower who suffered a major haemorrhage when an enthusiastic member of her audience shoved dollar bills into her belt causing three blades in her oesophagus to scissor.
In a short report published by Brian Witcombe in the British Medical Journal, November 5th, 2005, the author reports how sword swallowing played a useful role in helping to develop a new medical technique: "A sword-swallower helped Dr Kussmaul of Freidberg to develop a rigid endoscope in 1868 using a straight tube, mirrors and a gasoline lamp."
Both Witcombe and Meyer advise people not to do sword-swallowing because the risk of injury is too high. Meyer says he does it because there are so many gimmicks and illusions on TV. Sword swallowing is real and he likes to watch faces in the audience appreciating how incredible the human body is.
William Reville is associate professor of biochemistry and public awareness of science officer at UCC - understandingscience.ucc.ie