Award-winning research pinpoints dangers of sword swallowing

A British radiologist has won a spoof Nobel medical prize for his research into the ancient art of sword swallowing.

Dr. Brian Witcombe, a consultant radiologist at Gloucestershire Royal Hospital, collaborated with Dan Meyer, executive director of the Sword Swallowers' Association International. Their paper about the medical complications of sword swallowing was published in the British Medical Journal (2006;333:1285-1287).

The duo received their award at the Ig Nobel ceremony, held at Harvard University in October and organized by The Annals of Improbable Research. The prizes are designed to recognize research that makes people laugh and then think. They are intended to spur interest in science.

Witcombe and Meyer gathered detailed information from 48 sword swallowers, the average age of whom was 31 years. The average age they learned sword swallowing was 25, and nine learned as teenagers.

Lower chest pain, often lasting days, followed some performances. Six of the sample suffered perforation of the pharynx or esophagus. Three had had surgery to the neck, and three others also had probable perforations. One was told that a sword had "brushed" the heart.

Other sword swallowers had pleurisy and pericarditis after injury, and another had a bread-knife removed transabdominally. Sixteen mentioned intestinal bleeding, varying in quantity from finding some blood on a withdrawn sword to large hematemeses requiring blood transfusion.

"A previous minor injury may lead to a more severe major injury, and injuries occur more often when multiple or unusual swords are used, or when a distraction causes the performer to lose focus," the authors said. "Occasionally, a sword is difficult to advance or retract, presumably due to spasm or dryness related to nervousness or soreness. Overforceful efforts to move the sword may cause trauma, which can result in esophageal perforation."

The performer who lacerated his pharynx was trying to swallow a curved saber. In another incident, a belly dancer suffered a major hemorrhage when a bystander pushed dollar bills into her belt, causing three blades in her throat to scissor. The performer who lacerated his esophagus and developed pleurisy had been distracted by a misbehaving macaw on his shoulder while swallowing seven swords at once.

Witcombe is not the first European radiologist to study the medical aspects of sword swallowing. Dr. Rienhart Wolf and Dr. Allard Krikke from Groningen University Hospital in the Netherlands displayed a stunning poster, "The X files of sword swallowing," at the 1998 RSNA meeting and the 1999 European Congress of Radiology. While the authors were attending a performance of the New Jim Rose Circus, a tattooed sword swallower called Enigma fell from the stage. They delivered first aid on the scene, and Enigma then allowed them to take x-rays of him while he was performing his art.

"Sword swallowing is enabled by extreme control over the voluntary musculature of the oro- and laryngopharynx and active inhibition of the involuntary cricopharyngeus muscle," they said. "During the introduction of the sword, the gag reflex is suppressed. Then in a single, gentle, smooth movement, the three-foot long sword is advanced deep into the esophagus until it reaches the lower esophageal sphincter."