It is pretty amazing when you reflect upon it that you can sit at a dinner party enjoying yourself extravagantly—eating, talking, laughing, breathing, slurping wine—and that your nasopharyngeal guardians will send everything to the right place, in two directions, without you having to give it a moment’s consideration. That’s quite an accomplishment. But there is even more to it than that. While you are chattering away about work or school catchment zones or the price of kale, your brain is closely monitoring not just the taste and freshness of what you are eating but also its bulk and texture. So, it will allow you to swallow a large “wet” bolus (like an oyster or a lump of ice cream) but insists on more meticulous chewing for small, dry, sharp items like nuts and seeds that might not pass so smoothly.
Meanwhile, you, far from assisting this critical process, just keep pouring more red wine down your throat, destabilizing all your internal systems and seriously compromising your brain’s functional capabilities. To say that your body is your long-suffering servant is to put it mildly.
When you consider the precision required, and the number of times in a lifetime the systems are challenged, it is extraordinary that we don’t choke more often. According to official sources, about five thousand people in the United States and some two hundred in Britain choke to death on food each year—which is odd because those figures, adjusted for population, indicate that Americans are five times more likely to asphyxiate while eating than Britons.
Even allowing for the gusto with which my fellow Americans chow down, that seems unlikely. It is more probable that a lot of choking deaths are misattributed as heart attacks. Suspecting as much, a coroner in Florida named Robert Haugen many years ago looked into the deaths of people who had supposedly died of heart attacks in restaurants and, without much difficulty, found nine who had in fact choked. In an article for The Journal of the American Medical Association, he suggested that choking deaths were much more common than generally thought. But even using the most cautious estimates, choking is the fourth most common cause of accidental death in America today.
The well-known solution to a choking crisis is the Heimlich maneuver, named for Dr. Henry Judah Heimlich (1920–2016), a surgeon from New York who invented it in the 1970s. The Heimlich maneuver consists in embracing a choking victim from behind and giving him or her a series of sharp hugs at the breastbone, to force out the blockage, like a cork from a bottle. (For the record, the burst of air is known as a bechic blast.)
Henry Heimlich was something of a showman. He promoted the procedure, and himself, relentlessly. He appeared on The Tonight Show with Johnny Carson, sold posters and T-shirts, and talked to groups large and small across the country. He boasted that his method had saved the lives of Ronald Reagan, Cher, New York’s mayor Ed Koch, and several hundred thousand others. He was not always terribly popular with those close to him. A former colleague called Heimlich “a liar and a thief,” and one of his own sons accused him of practicing a “wide-ranging, 50-year history of fraud.” Heimlich seriously undermined his reputation by championing a treatment called malaria therapy, in which people were purposely infected with low doses of malaria in the belief that it would cure them of cancer, Lyme disease, and AIDS, among much else. His claims for the treatment were not supported by any actual science. Partly because he had become an embarrassment, in 2006 the American Red Cross stopped using the term “Heimlich maneuver” and started calling it “abdominal thrusts.”
Heimlich died in 2016 aged ninety-six. Shortly before his death, he saved the life of a woman at his nursing home with his own maneuver—the only time in his life that he had an opportunity to use it. Or possibly not. It emerged afterward that he had claimed to have saved someone else’s life on another occasion. Heimlich, it seems, maneuvered the truth as well as trapped lumps of food.
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The greatest choking authority of all time was almost certainly a dour American doctor with the luxuriant name of Chevalier Quixote Jackson, who lived from 1865 to 1958. Jackson has been called (by the Society of Thoracic Surgeons) “the father of American bronchoesophagoscopy,” and he was most assuredly that, though it must also be said there were not a lot of other contenders. His specialty—his obsession—was with foreign objects that had been swallowed or inhaled. Over a career that lasted almost seventy-five years, Jackson specialized in designing instruments and refining methods for retrieving such objects, and in the process he built up an extraordinary collection of 2,374 imprudently ingested items. Today the Chevalier Jackson Foreign Body Collection is housed in a cabinet in the basement of the Mütter Museum of the College of Physicians of Philadelphia. Each object is fastidiously cataloged by age and sex of the swallower; type of object; whether it lodged in the trachea, larynx, esophagus, bronchus, stomach, pleural cavity, or elsewhere; whether it proved fatal or not; and by what means it was removed. It is presumed to be the world’s largest assemblage of the extraordinary things people have put down their throats, whether by accident or bizarre design. Among the objects Jackson retrieved from the gullets of the living or dead were a wristwatch, a crucifix with rosary beads, miniature binoculars, a small padlock, a toy trumpet, a full-sized meat skewer, a radiator key, several spoons, a poker chip, and a medallion that said (perhaps just a touch ironically) “Carry Me for Good Luck.”
Jackson was a cold and friendless man by all accounts, but there seems to have been some kindness buried within him. In his autobiography, he recorded how on one occasion he removed from a child’s throat “a grayish mass—perhaps food, perhaps dead tissue”—which had kept her from swallowing for some days, then had his assistant give her a glass of water. The girl took a cautious sip and it went down, then took a larger sip. “Then she gently moved aside the glass of water in the nurse’s hand, took hold of my hand and kissed it,” Jackson recorded in the sole incident in his life that seems to have touched him.
In the seven and a half decades he was active, Jackson saved hundreds of lives and provided the training that allowed others to save countless more. Had he been a touch more charming with patients and colleagues, he would doubtless be better known today.
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It will not have escaped your attention that the mouth is a moist and glistening vault. That’s because twelve salivary glands are distributed around it. A typical adult secretes a little less than one and a half quarts a day. According to one calculation, we secrete about 31,700 quarts in a lifetime (about as much as you would get in two hundred or so deep baths). Just recently it was discovered that saliva also contains a powerful painkiller called opiorphin. It is six times more potent than morphine, though we have it only in very small doses, which is why you are not perennially high or indeed notably pain-free when you bite your cheek or burn your tongue. Because it is so dilute, no one is sure why it is there at all. It is so unassertive that its existence wasn’t even noticed until 2006.