In 19^th century Europe, daydreaming endoscopy pioneers found powerful inspiration in street entertainers plying a trade outside their windows — forever changing the course of modern medicine.

What those inventors saw in performers who could plunge swords down their throat was the very real possibility of introducing a tube into the aerodigestive tract.

In fact, some of the earliest subjects who demonstrated rigid esophagoscopy — an examination of the upper GI tract — were professional sword swallowers. That’s according to an article written by Dr. Ray Clarke, an ENT surgeon and an associate postgraduate dean at Alder Hey Children’s Hospital in Liverpool, in ENT & Audiology News .

For early endoscopists, a huge challenge was guiding light into their patient’s body and back out again without benefit of modern technology. What once required candles, oil lamps and an elaborate system of rigging mirrors to project light into a primitive endoscope evolved into the high-tech endoscopes of today, with their own light sources and cameras.

International Sword Swallower’s Awareness Day, celebrated on Feb. 25, 2023, is a day when sword swallowers around the world will swallow swords together — to raise awareness of this peculiar art as well as medical science.

Every critical care doctor or other physician who uses a bronchoscope or other endoscope to diagnose and treat patients should remember to thank a sword swallower on the last Saturday of February.

Now, more than 250 million endoscopies are performed each year globally, according to Strategic Market Research.

Endoscopies are less invasive than surgery and are used to diagnose and treat diseases in body cavities. Because endoscopy is quick and provides detailed images, it is valuable in many clinical settings.

Today’s single-use endoscope options — which endoscopists simply discard after the procedure — paired with HD monitors are a stark contrast to those primitive, early days.

“Modern-day endoscopic surgery, with high-fidelity screens, monitors, and the seemingly endless possibilities of navigating body cavities through ever smaller incisions, would surely have seemed impossible to the early pioneers of endoscopy,” Clarke wrote.

Inspiration for the Gastroscope

Adolf Kussmaul, a physician studying endoscopy in his clinic in Freiburg, Germany, was one of the first to incorporate the skill of local sword swallowers into his research.

During the 1850s, Kussmaul was able to visualize the esophagus and fundus using a 47-cm long, 13 mm diameter rigid device with an external gasoline lamp, with the help of a sword-swallowing associate. He took the sword swallower around to clinics with him to demonstrate his technique.

This preliminary research led to the development of the first clinically-used gastroscope.

It was Gustav Killian, the pioneer of "suspension laryngoscopy" — which frees a surgeon to work with both hands — and of rigid bronchoscopy who helped popularize the procedures in Germany in the late 1800s.

At the turn of the 20^th century, once electric lightbulbs became widely available and doctors could see what they were doing, the practice became more practical, Clarke wrote.

Millions of patients have benefited from this early work, which led to new inventions and methods of care. Devices became easier for patients to tolerate and eventually flexible versions and sedation were invented.

Sword swallowers not only played a key role in pioneering endoscopy, but also in the development of  the x-ray, fluoroscopy and electrocardiograms.

How Did Sword Swallowing Start?

It was thousands of years ago, in ancient Indian villages, that shaman priests first practiced the art of sword swallowing to show their power and as a way to bond with their gods.

The practice spread to China and Japan and was seen at festivals in Rome and Greece.

Sword swallowing didn’t reach the U.S. until the 19^th century. It was a hit feature of the 1893 Chicago World’s Fair, giving birth to a new generation of sword swallowers who entertained in traveling sideshows between 1899 and the 1950s. After that, sideshows fell out of favor as TV, the internet, video games and other forms of entertainment took over.

How Do Sword Swallowers Do It?

Sword swallowing can take from two to seven years to learn, according to swordswallow.com. There are estimated to be fewer than several dozen professional sword swallowers actively performing the ancient art today.

Sword swallowers use mind-over-matter techniques to repress the natural gag reflex in the back of the mouth, the peristalsis reflex in the throat, and the retch reflex in the stomach to "swallow" swords from 15-30 inches in length.

Still, a sore throat (known as sword throat) is a common side effect, according to a  study of 46 sword swallowers published by the British Medical Journal.

To read the first international medical study on sword swallowing, entitled “Sword Swallowing and its Side Effects,” published in the British Medical Journal in 2006, click here.

For more information or to schedule a local sword swallower for a medical demonstration, click here.

A Brief History of the Endoscope:

16^th Century:  The first documented redirection of sunlight into the human body

1850s: Adolf Kussmaul used sword swallowers to advance his research into visualization of the esophagus

1876: Gustav Killian removed a pork bone from a farmer’s airway using an esophagoscope

1895: Alfred Kirstein directly visualized the vocal chords

1904: Chevalier Jackson, an American otolaryngologist, laid the groundwork for the modern rigid bronchoscope

1967: Shigeto Ikeda invented the first flexible bronchoscope

2009: Ambu introduced the world’s first single-use flexible videoscope

­­­­­­­­­­­­­­­