longer swords, many swords, hot swords, bayonets or glowing neon tubes. Sword swallowers appeared on the same bill as magicians, such as Houdini. Western Europe and England also saw an increase in sword swallowing interest during this period, with many cross-Atlantic influences. During the late 19th century and early 20th century, traveling magic shows from the Orient toured Europe and America; some included sword swallowing. The middle of the 20th century saw a demise in circuses in general and sideshows in particular. Anatomy and method The performer must first lean the head back, hyper-extending the neck, and relax the upper esophageal sphincter (a generally involuntary muscle that contracts the top of the esophagus). Retching must be controlled while the sword, lubricated by saliva, is inserted through the mouth and past the pharynx. According to a study on 8 "normal subjects", the transverse diameter of the pharynx at its smallest point is on average 1.7±0.5 cm. Once past the pharynx and esophageal sphincter, the sword passes swiftly, assisted by gravity, straightening the flexible esophagus. The stomach, at an angle to the esophagus, is brought into line as the sword enters through the cardiac opening. Some swallowers consume a large meal or drink water before performing to give the stomach a more vertical orientation, allowing for easier passage of the sword. Careful focus is required to complete the process without injury, as the sword passes within millimetres of vital body parts such as the aorta, heart and lungs. Physical consequences Most serious sword swallowing injuries and fatalities occur after minor injuries or while attempting a feat beyond that of a normal sword swallow. The most common injury is a sore throat when first learning, after frequent consecutive performances, or after swallowing curved swords or several swords at once. Swallowing multiple swords simultaneously over time can also lead to distension of the esophagus. A minor injury may predispose the performer to sustaining a more major one, including perforation of the esophagus, stomach, heart, lungs, and other organs in proximity to the path of the sword, or intestinal bleeding. Twenty-nine deaths have been reported as a result of sword swallowing injuries since 1880. Medical case reports A 59-year-old man experienced chest pain and severe dysphagia following practice for his sword swallowing act. An esophageal perforation was found and surgically repaired; 19 days later a leak at the site required a transhiatal esophagectomy with a