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(AM-4: dp. 950 (est.), 1. 187'10; b. 35'6; dr. 9'9Ms; s. 14 k. (est.); cpl. 78; a. 2 3; cl. Lapwing)
Swallow (AM-4) was laid down at New York City on 18 March 1918 by the Todd Shipyard Corp.; launched on Independence Day 1918, sponsored by Miss Sara V. Brereton, and commissioned on 8 October 1918, Lt. B. C. Philips in command.
Following commissioning, Swallow underwent minor adjustments and prepared for foreign service. On 6 April 1919, she steamed out of Boston Harbor, bound for Inverness, Scotland. There she joined the Minesweeping Detachment of the Northern Barrage. For most of the remainder of 1919. Swallow sweet mines from the North Sea Barrage laid by the Allied and Associated Powers during World War I.
The minesweeper returned to the United States late in 1919 and put into the navy yard at Charleston, S.C., for overhaul and repairs. Early in 1920, she sailed for the west coast and then north to Bremerton, Wash. For the next 18 years, Swallow operated along the northwestern Pacific coast of North America spending much of her time in Alaskan waters. In 1934 she became a unit of the Aleutian Islands Survey Expedition.
On 19 February 1938, Swallow ran aground at Kanaga Island and was stranded there. Salvage efforts soon proved impracticable and her name was struck from the Navy list on 5 May 1938.
US Navy USS Swallow operating records
Collection number: HMC-0691.
Creator: United States. Navy.
Title: United States. Navy USS Swallow operating records.
Dates: 1931, 1935-1936.
Volume of collection: 0.02 cubic feet.
Language of materials: Collection materials are in English.
Collection summary: Routine records of Navy minesweeper wrecked on Kanaga Island in 1938.
The USS Swallow was a Navy minesweeper stationed at Puget Sound Navy Yard, Bremerton, Washington. In the spring of 1934, the Navy dispatched the ship, along with five other minesweepers, to begin an extensive charting expedition in the Aleutian Islands. This mission was to augment the regular operations of the U. S. Coast and Geodetic Survey fleet in the North Pacific. This flotilla was commanded by Rear Admiral Sinclair Gannon. The commanding officer of the Swallow was Lieutenant Bern Anderson, and the executive officer was Chief Boatswain J. W. Collier. On February 19, 1938, the ship was stranded on the rocks of Kanaga Island while entering Kanaga Harbor and was declared a total loss. The Swallow’s forty officers and crew came aboard the Coast Guard cutter John C. Spencer, and were taken to Dutch Harbor, Alaska.
The collection consists of routine ship’s operating records for the U. S. S. Swallow. The collection contains: a compass report (Nov. 2, 1931) memoranda of the ship’s organization, daily and weekly routines while in port, and daily routine while at sea (Nov. 12, 1935) ship’s orders concerning anchor watch duties, uniforms, standard engine speed, crew compartments, telephone use, and watch list while in navy yard (Nov. 12-13, Dec. 4, 1935, and Feb. 15, Nov. 9 & 12, 1936) a memorandum for all hands concerning the untidiness of crew compartments (Dec. 4, 1935) and a messing bill assigning tables to officers and crew and the times of first and second mess (Jan. 9, 1936).
Arrangement: The documents in this collection are in the order in which they were provided to the Archives.
Digitized copies: This collection has not been digitized. For information about obtaining digital copies, please contact Archives and Special Collections.
Rights note: In general, federal government documents are not subject to copyright restrictions.
Preferred citation: United States. Navy USS Swallow operating records, Archives and Special Collections, Consortium Library, University of Alaska Anchorage.
Related materials: Photographs of the wrecked ship are located in the Alan May papers, HMC-0690 within his personal journal/scrapbook for the 1938 Archaeological Expedition of the Smithsonian Institution to the Aleutian Islands.
Custodial history: The records were salvaged from the ship at Kanaga Island by Alan May.
Acquisition note: The collection was given to the Archives by Alan May in 1989.
Processing information: This collection was originally described by Jeffrey Sinnott in 2004. The finding aid was updated to current standard by Arlene Schmuland in 2011.
Wichita's Aviation History
The month of November is aviation history appreciation month. Wichita lays claim to the title &ldquoAir Capital of the World,&rdquo and it has been a long road to get there. Here&rsquos the history of how it came to be.
Wichita can trace its roots in aviation back to the likes of Walter Beech, Clyde Censa, E.M. &ldquoMatty&rdquo Laird, Bill Lear, J.M. Mollendick, Lloyd Stearman and George Weaver, all who built the companies that laid the groundwork for Wichita&rsquos prominent aviation industry.
Clyde Cessna built his first plane near Rago, Kansas, with his first successful flight being in December of 1911 after several failed attempts. He, in 1916, moves his airplane manufacturing business from Kingman County, where his farm was, to Jones Auto Factory in north Wichita. The first plane known to have been completed in Wichita was Cessna's "The Comet" in 1917.
Wichita Aeroplane Service Co. and Wichita Aircraft Co. form in Wichita in 1919. J. M. Moellendick, who prospered during the El Dorado oil boom, invested in the Wichita Aircraft Company. Disliking how the management was running things he persuades William Burke to take over. Burke flew to Chicago, met with E.M. &ldquoMatty&rdquo Laird, and proposed the three form an aircraft company in Wichita.
Swallow On Display at KAH
Matty Laird, Billy Burke, and Jake Moellendick form E.M. Laird Airplane Company in 1920. The first plane produced was originally known as the Wichita Tractor. It first took flight in April of 1920, when William Lassen, a young man watching the flight, is claimed to have remarked "She flies like a swallow, boys." From then on the plane has been referred to as the Laird Swallow.
In 1923 Laird returns to Chicago, selling his share of the business to Moellendick. The name then changes from E.M. Laird Airplane Company to Swallow Airplane Company. Laird restarts E.M. Laird Airplane Company in Chicago. Around this same time Lloyd Stearman and Walter Beech are both working for Moellendick at Swallow.
Lloyd Stearman and Walter Beech leave Swallow, late in 1924, due to a disagreement with Moellendick, and form Travel Air in 1925 along with Clyde Cessna. Stearman also forms his own company in California in 1926.
In 1927 Cessna Beech and Stearman part ways after a disagreement over what type of wings to produce. Stearman moves his company from California back to Wichita.
Cessna Aircraft Company is formed in 1928. This same year Wichita begins promoting itself as "The Air Capital of the World". A fitting title as Wichita turned out a quarter of all U.S. aircrafts. The city was home to 16 airplane manufacturers, six engine factories, 11 airports, a dozen flying schools and many more suppliers.
The Wichita Municipal Airport, was built starting in 1930, but was not completed until 1935 due to the Great Depression. Wichita Municipal Airport served the city for 17 years before the Air Force built a base and began to use the airport for its own operations.
Also in 1930, Beech's Travel Air merges with United Aircraft and Transport, which included Boeing. This new entity also took over Stearman Corporation. This same year Al Mooney formed the Mooney Aircraft Corporation in Wichita.
In 1932, Walter Beech and his wife Olive form beech Aircraft Company. The first Beechcraft, the Model 17R Staggerwing, takes flight in November of that year.
The "world's most efficient airplane" (at the time), the Cessna Airmaster, originally the model c-134, began production in 1935.
World War II causes a boom in the Aviation industry as manufacturers step up production to meet the war efforts. Tens of thousands of aircraft workers are employed in plants throughout Kansas, most of them being in Wichita. Boeing built the B-29 bombers. Beech and Cessna built various military aircraft models. Many companies cooperatively produced gliders together.
Boeing was the first company to institute a mass transit system for its employees. They would bus-in employees from downtown Wichita as well as from surrounding cities. Buses would even run routes as far as Ponca City, Oklahoma.
Unfortunately, what goes up must come down. When World War II stopped, so did the high demand for planes. This resulted in 16,000 people being laid off in a single day from Boeing plants.
There was still advancement, however, in the aviation industry. Beechcraft flew their first Bonanza in 1945, and Al Mooney re-entered the manufacturing scene with Charles Yankey to form Mooney Aircraft Inc. in 1946. A year later Boeing would begin its initial aerial refueling tests with their B-29's.
The Boeing B-47 rolls off the production line in 1951. This is the United States' first swept wing bomber. In January of this year, the United States Air Force announces plans to build a large air force base at what was then the Wichita Municipal Airport. They used the base for crew training on the B-47's.
With the USAF using the airport for military operations it was necessary for Wichita to get a new commercial airport. Construction on Mid Continent Airport began in 1954. All non-military flight traffic stopped out of the municipal airport that same year.
Also in 1954, Boeing began production of the B-52 Bombers, a model still flying active missions today.
Cessna flew its first Model 172 in 1956. This plane would later go on to be the most produced plane in history with over 43,000 units produced.
*Image Courtesy of Wikipedia.org
Bill Lear moved from Switzerland to Wichita to design a business jet. The first Learjet took flight in October of 1963. Cessna followed to launch its own business jet prototype in 1969. This prototype later became the Cessna Citation.
Beech Aircraft is acquired by Raytheon Co.
In 1983, Beech announced plans for the all-composite Beech Starship. Marketing and Certification issues plague the Starship, halting production after about 50 unites are delivered.
Military operations at Wichita Municipal Airport cease in 1984.
By 1986, Cessna temporarily stops production of the popular Model 172. Up to this point 35,000 units have been produced. The stop in production is due mostly to rising product liability costs. General Dynamics acquires Cessna this same year.
The 90's brought a series of acquisitions of Wichita Aviation companies. Bombardier purchased Learjet in 1990, and Textron purchased Cessna from General Dynamics in 1992. Beechcraft, purchased by Raytheon in 1979, is renamed Raytheon Aircraft Co. in 1994.
The Wichita Municipal Airport, out of use since 1984, becomes the Kansas Aviation Museum.
Cessna begins production on the Model 172 again in 1996, but this time from a plant located in Independence, Kansas. This same year, Boeing launches its first one-piece fuselage for its Next-Generation 737-700.
Bombardier opens a 98,000 square-foot expansion to its Flight Test Center in 1997. Boeing merges with McDonnell Douglas Corporation.
In an effort to consolidate the Air Force's B-1 Fleet, McConnell Air Force Base's B-1B Lancers are moved to other bases. The 184th Bomb Wing at McConnell takes on the mission of flying the KC-135s and is designated as the 184th Air Refueling Wing.
Onex purchases Wichita /Tulsa division of Boeing, in 2005, this becomes Spirit AeroSystems.
2006 sees the 5,000th Boeing 737 to come off the production line, the 737s go through final assembly in Seattle, but the fuselages are assembled here in Wichita by Spirit Aerosystems.
Onex and Goldman Sachs also purchase Raytheon in 2007, they choose to rename the plant Hawker Beechcraft.
Mid-Continent Airport retires after over 60 years of service earlier this year with the opening of the new Wichita Dwight D. Eisenhower National Airport. The new terminal properly reflects this city as being "The Air Capital of the World."
Today, Wichita is still a hub of aviation. With around 30 airfields (both public and private) in Sedgwick county, over 20,000 employees at the major aviation manufactures and many more in aviation related roles in Wichita.
*Timeline and Historical photos courtesy of Kansas Aviation Museum
*New Terminal image courtesy of Wichita Dwight D. Eisenhower National Airport.
Swallow Sidecar Company history
The Swallow Sidecar Company was founded on 4 September 1922 by two friends, William Walmsley and William Lyons . Both families lived in the same street in Blackpool, England. Walmsley had previously been making sidecars and bolting them onto reconditioned motorcycles. Lyons had served his apprenticeship at Crossley Motors in Manchester before moving to Brown and Mallalieu as a junior salesman.
Lyons, having recognised the commercial potential for these sidecars, joined Walmsley and together they obtained premises in Blackpool with the assistance of a £1,000 overdraft. With a small team of employees they were able to begin commercial production of the motorcycle sidecars.
The company diversified in 1926, changing its name to the Swallow Sidecar and Coachbuilding Company and moved into the car coachwork business. The first car that Lyons and Walmsley worked on was the Austin 7, a popular and inexpensive vehicle. Lyons had persuaded a dealer in Bolton, Lancashire to supply him with an Austin 7 chassis and commissioned Cyril Holland, a coachbuilder from the Midlands, to create a distinctive, open tourer body. The result was the 1927 Austin Seven Swallow.
Priced at only £175, the Swallow, with its brightly coloured two-tone bodywork and a style that imitated the more expensive cars of the time, proved popular at a time of financial hardship for many. Soon after, a saloon version was produced: the Austin Seven Swallow Saloon.
In 1927 the "Sidecar" was dropped from the name, and it became the Swallow Coachbuilding Company.
The increasing demand for Swallows made it necessary to move the company closer to the heart of the British car industry and so, in 1928, they moved to a part disused First World War munitions factory at Holbrook Lane, Coventry. Business continued to grow and in 1929 the company was sufficiently confident to go to the expense of taking a stand at the London Motor Show.
Three new Swallow models appeared in 1929, based on Standard, Swift, and Fiat chassis. Also in 1929 John Black and William Lyons realised a long standing dream and produced a one of a kind sports car, This "First" SS (Standard Swallow) was a sleek Boat Tail Roadster with a flowing, streamlined design and pointed to an obvious attempt at making a fast car, possibly with the intention of venturing into racing. This car is believed to have been shipped to Australia in the late 40s.
Lyons wanted to move away from just being a coachbuilder and reliance on other manufacturers' existing chassis. He commissioned a custom chassis from the Standard Motor Company, fitted with either a 2 or 2.5 litre Standard engine. At the 1931 Motor Show he unveiled the S.S.1 coupé a two-seater sports car with the designation SS 90 with six-cylinder engines of 16 and 20 HP.and a smaller 1 litre version, the S.S.II with 10 and 12 HP.
In 1933, the company took over the coachbuilder Holbrook Bodies at Holbrook Lane in Coventry for expansion .
The continued success and expansion of the SS range resulted in the creation of the S.S. Cars Ltd motor company by Lyons in 1934. Walmsley, who did not share Lyons' ambitions, left the company at this time.
In October 1935 Lyons presented its first four-door sedan, for which the standard engine with the help of Harry Weslakes uspended valves (OHV) improved and thus gave over 100 hp. Again, there was a variant with a four-cylinder engine of well 1.5 liters capacity, which also had valves on the side. The six-cylinder high-performance engine was also used in the previous SS 1 Tourer and the sports car, which was now almost capable of 100 mph (160 km / h) and therefore was called. SS 100
These new SS models were compared to similar cars from Bentley or Alvis very cheap, so that "Jaguar" from the beginning had the reputation of a particularly inexpensive sports sedan. The top model was the end of 1937, the 3.5 liter with 125 bhp added, both in the sedan and in the sports car. At the same time a two-door convertible version with all three engine sizes was presented, the Drophead Coupé .
After the Second World War, due to the unfavourable connotations of the SS initials, the company was renamed Jaguar Cars Ltd in 1945.
Sidecar production was now by Swallow Coachbuilding Co. (1935) Ltd. of Albion Road, Birmingham.
At the end of 1945, the Helliwell Group, an aircraft maintenance firm, bought the name and goodwill of the now defunct Swallow side car manufacturer, Swallow Coachbuilding Company (1935) Ltd, from SS Cars Limited. Sidecars produced at Helliwells' Walsall Airport works were built in the same way as the originals and used the same patented trademark.They closed shop in the early 1960s.
Swallow Coachbuilding Co. (1935) Ltd. has been registered in the UK by Peter Schömer & Michael A.R Burchett #07720862 for the purpose of building a new 3 wheel sportscar using the Harley Davidson Twincam EVO engine. It will be called the Swallow V-Twin and made in 2 models based on the Swallow Sidecars of 1935 Touring and Speedster. Both will be manufactured in Chichester, West Sussex, England.
The "SWALLOW" logo has been registered with the Intellectual Property Office in England as #2591789 by the Swallow Coachbuilding Co. (1935) Ltd.
What Makes Injections Hard to Swallow?
An anthropological assessment of the differences between pills and injections may shed some light on vaccine hesitancy.
I f you’re watching a news show or reading a magazine article about vaccine hesitancy, you might find your program interspersed with advertisements for prescription medications: beguiling ads of cheerful, energetic people promising relief from everything from arthritis to late-stage cancer.
T he juxtaposition seems completely illogical: How did some people develop a simultaneous rejection of certain medications and a whole-hearted zest for others?
A s an archaeologist, I’m fascinated by the diversity of objects our ancestors have invented over millions of years, including those that people have used to introduce substances into their bodies. That includes culinary equipment associated with food production and the containers and accoutrements for medicines, enhancements, placebos, and recreational drugs. These objects have an intimate link to human perceptions of health and sickness—an essential part of our identity and daily routine, encompassed by the ubiquitous inquiry: “How are you?”
M y work has led me to think about the human relationship with different mechanisms of medical delivery, particularly the pill and the injection. They differ in so many important ways: our level of independence in taking them, our level of comfort, and, importantly, the intended purpose of the drug for healing in the pressing present or protecting against a faraway future.
T he human eagerness to take pills but a reluctance by some to be vaccinated surely has a lot to do with modern politics and social factors. But it also has roots deep in our ancestral past.
A t this moment in history, as the planet undertakes a massive vaccination program, it seems ever-more important to understand these differences and to leverage lessons from the past as we move into the future.
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T he use of medicine has a very long history. Archaeologically, we know that the use of medicinal plants long preceded the development of domesticated plants. The knowledge of compounding goes back to the very earliest uses of writing, when recipes for both ingested and topical medications were some of the first things that scribes captured on clay, bamboo, and other surfaces.
A 3,600-year-old Egyptian papyrus, for example, provides “A Recipe for Transforming an Old Man Into a Youth.” The formula is quite complicated, involving large quantities of something called hemayet fruit that is bruised, dried, sifted, mixed with water, cooked, evaporated, and dried again, then rehydrated in river water, spread out to dry in the sun, and ground into a powder.
Ö tzi the Copper Age traveler, whose frozen body was found in the Italian Alps in 1991, had in his kit bag two pieces of Piptoporus betulinus, a bracket fungus that has a flushing effect against intestinal parasites. (His autopsy revealed that he suffered from intestinal trouble—as most people probably did back then.)
Some medical practices of healing go back thousands of years. DEA Picture Library/De Agostini/Getty Images
W hile the practice of eating medicinal substances has likely been around for millions of years (even nonhuman primates self-medicate), injections are comparatively new. Projectiles such as spears and bullets have a long history of piercing the skin—but for purposes of harm.
E ven after people developed invasive techniques to help rather than hurt, including acupuncture, amputation, and trepanation, there was still little experience of using violence to insert a compound into a person’s body with the counterintuitive goal of improving their health. Tattooing is one example: There is some evidence that millennia-old Indigenous tattoo practices were done in part to introduce therapeutic compounds. The idea of inoculating someone with traces of a disease to protect them seems to go back to before the 1500s in the Ottoman Empire. In Europe, the first vaccine was developed against smallpox in 1796. The first hypodermic syringe only dates to the 1850s.
Fear of needles may be as old as needles themselves and remains a problem even for those who require regular self-administered injections for their health, as with people who have diabetes.
L ikewise, our long medicinal history was primarily focused on the ills of the here and now. While there is a relatively long history of preventive medicine stretching back thousands of years (for example, in China, India, and ancient Greece), our ancestors were surely more concerned with of-the-moment illness and injury than with future wellness. People well into the 19th century faced perpetual death and danger as very real wolves at the door. There was already plenty of pain and discomfort the thought of adding more pain in the present to a healthy individual in order to forestall some possible future catastrophe would surely have made little sense.
A vaccine, counterintuitively, is taken when you’re well. You accept a physical pain (a pinch in the arm followed by side effects that can range from mild to severe) against an unknown future gain (a large statistical likelihood of protection against a deadly disease). This tradeoff means that vaccines join other things that are good for us that we don’t enjoy and often don’t do, like flossing or saving for retirement.
A vaccine, counterintuitively, is taken when you’re well.
I ndeed, the challenges of imagining future benefits may be a critical part of the human story. Human cognitive misgivings surrounding pay-now/play-later activities are at the heart of many of our contemporary conundrums about health, economics, education, and climate change.
A final important distinction among medical applications is the notion of autonomy. Whether it’s swallowing a tablet, drinking a potion, or slapping a patch on your arm, the do-it-yourself approach seems to be popular: Hospital studies show that patients prefer to be in charge of their own medication.
B y contrast, injections usually are given to you by a professional “other” who has special equipment and training they are invasive procedures, done in commercial or institutional settings that may feel clinical and cold rather than comforting. It’s notable that when it comes to female hormonal birth control, pills are more popular than injections, even though the latter last longer and could enable people to avoid having to remember a daily pill.
P ills are perhaps the ultimate modern manifestation of the practice of self-treatment. As you take a pill, you can feel the effects of swallowing it and can often measure the impact in a matter of hours or less. Even if the effects are long-term or imperceptible, the psychological impact of taking a pill (even if it is a placebo) is significant. Drug manufacturers have learned to harness everything about pills, including their shape, size, and color, to produce the maximum desired effect. Advertisers know what they’re doing: They make people feel that by taking specific drugs, they’ll be just like the vibrant people they saw on TV.
T he advent of what’s called “modern” medicine has arguably only been experienced within the last six human generations. It’s not surprising that our species is still coming to terms with narratives of health that involve preventive technologies delivered through invasive means.
B ut what if vaccines and other injections were reconceived in order to make the process more like taking pills?
T aste, visuals, and reformulated delivery mechanisms might be key elements to explore to make medicinal treatment more acceptable to deep-rooted human psychology. Small things can make a difference. The visual encouragement of vaccines, for example, is subtly encoded into Apple’s recently announced redesign of the syringe emoji to remove the potentially intimidating drops of blood that were part of the image.
Some vaccines have evolved from injections to pills, such as this anti-typhoid medication. K/Wikimedia Commons
O thers are working to shift injected medicines, when possible, to other delivery systems in part to make them more acceptable. The typhoid vaccine is now widely available in a pill form the seasonal flu vaccine can be administered as a nasal spray. Researchers have developed self-vaccination patches that have microneedles too small to feel one survey suggested that the number of people willing to have a seasonal flu vaccine leapt from 46 percent to 65 percent with this technology. Researchers, including University of Pittsburgh bioengineer Emrullah Korkmaz, are already exploring this possibility for COVID-19 vaccines as well.
N o doubt future medical treatments will continue to address our desire for autonomy in preventative and curative medicine, just as we cherish self-determination in other physical activities such as exercise, nutrition, and sex. With a little extra anthropological thought, we may well see a time when injections are part of the archaeology of medicine, with needles consigned to the dustbin of history.
The History of the Modified Barium Swallow Study
No matter what you call it…there is a history behind the Modified Barium Swallow Study (MBSS).
The Modified Barium Swallow Study has long been called THE gold standard in dysphagia evaluation, however it does have its limitations. The MBSS definitely continues to be A gold standard in swallowing evaluation.
In the 1970’s, Dr. Jeri Logemann developed the MBSS or the Cookie Swallow Test. She presented on this test at the ASHA convention in 1976.
During the Cookie Swallow Test, patients were given 2 cc of radiopaque liquid, 2 cc of paste, and 1/4 of a cookie coated with barium. The liquid barium was given first, then paste, and last, the cookie. Patients were recorded with 2 swallows of each consistency.
Dr. Logemann then described liquid/food presentation as 3 swallows each of:
- 1 ml thin liquid by spoon
- 3 ml thin liquid by spoon
- 5 ml liquid by syringe
- 10 ml liquid by syringe
- (can give larger amounts also)
- Cup drinks
- Saliva Swallow (no barium, just watch muscles move with swallow)
- Pudding with barium (1/3 tsp or 1 ml of 2 parts pudding to 1 part barium)
- Other food textures mixed with barium
Linden and Siebens, developed a new approach to the VFSS which was based on patient specific deficits. They used representative radiopaque foods similar to those the patient ordinarily ate. The study started with the food which would be safest for the patient to swallow, as determined by the SLP. The study then progressed to increasingly difficult foods/liquids ending with those the patient was most likely to aspirate. Compensatory maneuvers (such as modifications of feeding or positioning) were tested as a basis for developing recommendations for diet and treatment.
Dr. Bonnie Martin Harris recently developed the Modified Barium Swallow Impairment Profile (MBSImP) which is the first standardized assessment of the MBSS. (More on that to come!)
The MBSS consists of the patient, usually seated in a special seat, having an X-ray study, examining the oropharyngeal cavity. The patient is given a variety of liquids and food, all mixed with barium as the barium can be viewed during the real-time video of the study.
The study is typically (should be) recorded for review of the test later. The video can be slowed down for more accurate view of the swallowing structures.
Often, the MBSS is started and once the patient aspirates on the first consistency, the exam is discontinued. This should not be the case as modifications can be made to:
- amount presented
- method of presentation
- position of head when swallowing
Although at one point, most SLP’s were completing the MBSS study to determine penetration/aspiration and what the best diet consistency is for the patient to safely consume, we now know better.
The MBSS is a test that allows us to view the oropharyngeal structure from the side (lateral) and from the front (A-P view) to determine the physiology of the swallow, meaning that we determine what muscles are moving and how.
Although we may test a wide variety of consistencies, thin liquid, nectar thick (mildly thick), honey thick (moderately thick) liquids, pureed, mixed consistencies, soft foods and regular foods, there is no way for us to possibly test every single consistency the person may consume.
But Why MBSS?
That is why it is important to look beyond penetration and aspiration and to look at the physiology of the swallow including what is functional and what is not. This is what leads us to accurate diagnosis and treatment planning for patients.
Logemann JA. Manual for the videofluorographic study of swallowing. 2nd ed. ProEd Austin, TX: 1993.
Logemann JA. Evaluation and treatment of swallowing disorders. ProEd Austin, TX: 1998.
Martin-Harris, B., Brodsky, M. B., Michel, Y., Castell, D. O., Schleicher, M., Sandidge, J., … & Blair, J. (2008). MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia, 23(4), 392-405.
Linden PL, Siebens AA: Dysphagia: predicting laryngeal penetration. Arch Phys Med Rehab 64:281-284, 1983.
Siebens AA, Linden PL: Dynamic imaging for swallowing reeducation. GastrointestRadio110:251-253, 1985.
Linden P: Videofluoroscopy in the rehabilitation of swallowing dysfunction. Dysphagia 3:189-191, 1989.
Palmer, J. B., Kuhlemeier, K. V., Tippett, D. C., & Lynch, C. (1993). A protocol for the videofluorographic swallowing study. Dysphagia, 8(3), 209-214.
Martin-Harris, B., Brodsky, M. B., Michel, Y., Castell, D. O., Schleicher, M., Sandidge, J., … & Blair, J. (2008). MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia, 23(4), 392-405.
Martin-Harris, B., Logemann, J. A., McMahon, S., Schleicher, M., & Sandidge, J. (2000). Clinical utility of the modified barium swallow. Dysphagia, 15(3), 136-141.
Swallow Hill’s History
Founded in 1979, Swallow Hill Music began as an outgrowth of the Denver Folklore Center, a music store in Denver’s Swallow Hill neighborhood that offered music lessons and performances to the community in the 1960s and 1970s. When the Folklore Center closed temporarily in the late 1970s, a group of committed volunteers formed Swallow Hill Music as a nonprofit organization whose mission is to “bring the joy of music to life every day.” Since then, we have become a cultural asset and a distinct thread in Colorado’s musical fabric.
Learning From History: How to Swallow a Pill
In developed but more especially in developing countries, patients with major mental illness may suffer from nutritional deficiencies and may require iron supplements as part of nutritional correction efforts. Iron deficiency and psychiatric disorders may be related for example, a large, pediatric, population-based study 1 found that iron deficiency was associated with mood disorders, autism spectrum disorder, attention-deficit/hyperactivity disorder, and developmental disorders. Iron levels may be low in schizophrenia patients, especially those who develop akathisia. 2 Low iron levels have also been associated with geriatric 3 and perinatal 4 depression. Iron supplementation may be necessary in patients with restless legs syndrome. 5 Finally, women with psychiatric illness may experience menstrual disturbances if there is chronically increased menstrual flow, anemia may result and neuropsychological deficits may manifest. 6 The preceding description of the role of iron in psychiatry is not comprehensive it merely serves to draw attention to situations in which iron supplementation may be considered in patients with psychiatric disorders.
Patients receiving oral iron therapy are required to avoid lying down for 15-30 minutes after ingesting the medication. This and certain other precautions related to medication ingestion may, in fact, be desirable with many other medications, as well. What are the precautions, why are they necessary, and for which medications? Whereas gastroenterologists have long known of these matters, psychiatrists should also be aware of them because patients who receive iron supplements (and other medications requiring such precautions) may not read or may be unable to read the guidance in package inserts and may lack access to pharmacists who will provide the necessary advice at the time of dispensing the medications.
Evidence for Delayed Transit of Tablets Through the Esophagus
Nearly 4 decades ago, Evans and Roberts 7 remarked that the sensation of swallowed tablets "sticking" in the esophagus is common in fact, one of the authors had personally experienced dysphagia after ingesting an antimalarial tablet. These authors therefore conducted a simple study to determine how often tablets stick in the esophagus and the site at which the tablets lodge.
They 7 administered barium sulfate tablets to 98 consecutive patients (57% male) who were undergoing a routine radiologic study of the gastrointestinal tract no patient had known obstructive esophageal disease. The tablets were identical in size and shape to the common aspirin tablet. Each patient received 2 tablets along with just enough water (15 mL) to assist swallowing. The patients were asked to lie down immediately after swallowing the tablets and were subjected to fluoroscopic examination in the supine position. If the tablets remained in the esophagus for more than 5 minutes, the patients were asked to stand and were then reexamined at 10-minute intervals until the tablets entered the stomach.
The findings of the study 7 are summarized in Table 1 . Esophageal retention of tablets for > 5 minutes was observed in 58% of the sample. Upper gastrointestinal disease was a risk factor for tablet retention however, tablet retention was also observed in more than half of patients with a normal esophageal study. Of the 2 patients with the longest esophageal transit time, 1 had no radiologic diagnosis (transit time = 45 minutes), and the other had an esophageal stricture (transit time = 90 minutes).
Evans and Roberts 7 reported that they also had evidence of esophageal retention of capsules and of tablets smaller than the ones administered in their study. A limitation of their study is that it was conducted in patients who had been referred for radiologic investigation and who, consequently, would be more likely to show tablet retention. Another limitation is that the patients had been allowed only 15 mL of water to help them swallow their tablets. A strength of this study is that it illustrates risks in patients with known or suspected upper gastrointestinal disease and in those who habitually swallow their medications with little or no water and who lie down afterward.
Implications of Delayed Transit Through the Esophagus
Esophageal retention of a swallowed pill will delay absorption and hence the onset of action of the medication. This issue may not be clinically relevant with most medications and in most situations, particularly in psychiatric practice. More importantly, if a pill is lodged in the esophagus, it may cause local irritation and ulceration. This condition is known as pill-induced esophagitis or just pill esophagitis, an underreported condition that is well known to gastroenterologists and underrecognized by other medical specialists. 8-10
Patients who experience pill esophagitis commonly only suffer sudden-onset retrosternal pain. Although this pain is usually self-limiting, it can persist for several days in association with dysphagia. In some cases, esophageal hemorrhage, stricture, and perforation may occur, and fatality is a rare but possible outcome. 8-10
Iron-containing medications have long been known to cause pill esophagitis. Initiation or exacerbation of esophageal and gastric lesions by iron has been histologically demonstrated, 11,12 and fatality has been reported. 11 In a prospective endoscopic study of the upper gastrointestinal tract, Kaye et al 13 found that 15 of 93 (16%) patients receiving oral iron tablets had iron deposits evident on routine hematoxylin and eosin staining. Pooling these with data obtained from a retrospective data set, they found that, of patients with esophageal iron deposit, 6 of 7 (86%) had associated erosion of patients with gastric iron deposit, 29 of 46 (63%) had erosion and 37 (80%) had reactive gastritis.
Other pills that can cause painful erosions if they lodge temporarily in the esophagus include those that contain aspirin or nonsteroidal anti-inflammatory drugs, alendronate, doxycycline, tetracycline, macrolide antibiotics, antimalarials, and potassium. 8-10,14 In psychiatry, pill esophagitis has been reported with fluoxetine. 15 In fact, a large review 8 described pill esophagitis in association with nearly a hundred different medications in 979 patients. The management of pill esophagitis was summarized by Kikendall. 9
Risk Factors for Pill Esophagitis
In a histopathologic study of 12 patients with iron-related esophageal ulceration, Serck-Hanssen and Stray 11 observed that all patients were elderly and most were bedridden. Greater age may be associated with less efficient esophageal motility, and gravitational assistance to esophageal transit of medication might be diminished in the supine position. Thus, greater age and supine posture may be 2 predispositions to pill esophagitis. 9
Patients in the Evans and Roberts 7 study ingested their tablets with very little water this, therefore, is also likely to be a risk factor. 9 The authors 7 showed that esophageal retention of tablets is common even in patients who are upright after the first 5 minutes one wonders how much more frequent or prolonged the retention might have been if the patients were supine throughout the period of observation. Given that the patients were required to lie supine for the first 5 minutes, another possible implication is that once a tablet is impacted in the esophagus, it is not easily dislodged. This suggests the need for patients to remain upright for a short while after swallowing a tablet or capsule.
Anything that physically or physiologically impairs esophageal transit could increase the risk of pill esophagitis. Examples include disorders of esophageal motility, left atrial enlargement with resultant esophageal compression, hiatus hernia, and esophageal stricture. 8-10,14 Pill esophagitis may also be commoner with capsules, sustained-release formulations, and large or oddly shaped pills. 10
Given the literature that has been reviewed, the following recommendations are reasonable 7-10 :
- Tablets and capsules should be swallowed with a full glass of water so that the water will carry the medication into the stomach along with the peristaltic waves.
- Tablets and capsules should be ingested before or during a meal rather than after the meal so that the food will mechanically carry the medication into the stomach along with the peristaltic waves. This recommendation, of course, will not apply to medications that are specifically advised to be taken on an empty stomach thyroxine is one such example. 16
- Patients should not lie down for at least 15-30 minutes after ingesting a tablet or capsule peristaltic movement of the medication into the stomach may be aided by gravity if the medication has not already entered the stomach with the assistance of water and food, as described above. Patients receiving hypnotic drug therapy are usually asked to go to bed immediately after taking their medication. Whereas hypnotic drugs have not generally been associated with pill esophagitis, it could be good practice even for such patients to wait for about 5 minutes before lying down.
- These recommendations are especially relevant to medications that can damage the esophagus, such as iron, aspirin, anti-inflammatory drugs, alendronate, potassium, tetracyclines, macrolide antibiotics, and antimalarials. 8-10
- In some patients, these recommendations may not be implementable. For example, patients receiving electroconvulsive therapy (ECT) are allowed only a sip of water when they take their essential medications on the morning of an ECT session. Or, patients who are confined to bed may not be able to drink much or eat, nor may they be able to remain upright after ingesting their medications. Therefore, wherever possible, such patients should receive liquid, chewable, or mouth-dissolving (orodispersible) formulations or formulations that can be crushed before administration with water.
Pill esophagitis is a preventable condition. Providing the necessary guidance to the patient in order to minimize the risk of this condition should take less than a minute.
1. Chen MH, Su TP, Chen YS, et al. Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry . 201313(1):161. PubMed doi:10.1186/1471-244X-13-161
2. Kuloglu M, Atmaca M, Ustündag B, et al. Serum iron levels in schizophrenic patients with or without akathisia. Eur Neuropsychopharmacol . 200313(2):67-71. PubMed doi:10.1016/S0924-977X(02)00073-1
3. Stewart R, Hirani V. Relationship between depressive symptoms, anemia, and iron status in older residents from a national survey population. Psychosom Med . 201274(2):208-213. PubMed doi:10.1097/PSY.0b013e3182414f7d
4. Leung BM, Kaplan BJ. Perinatal depression: prevalence, risks, and the nutrition link: a review of the literature. J Am Diet Assoc . 2009109(9):1566-1575. PubMed doi:10.1016/j.jada.2009.06.368
5. Picchietti MA, Picchietti DL. Advances in pediatric restless legs syndrome: iron, genetics, diagnosis and treatment. Sleep Med . 201011(7):643-651. PubMed doi:10.1016/j.sleep.2009.11.014
6. Murray-Kolb LE. Iron status and neuropsychological consequences in women of reproductive age: what do we know and where are we headed? J Nutr . 2011141(4):747S-755S. PubMed doi:10.3945/jn.110.130658
7. Evans KT, Roberts GM. Where do all the tablets go? Lancet . 19762(7997):1237-1239. PubMed doi:10.1016/S0140-6736(76)91158-2
8. Kikendall JW. Pill esophagitis. J Clin Gastroenterol . 199928(4):298-305. PubMed doi:10.1097/00004836-199906000-00004
9. Kikendall JW. Pill-induced esophagitis. Gastroenterol Hepatol (N Y) . 20073(4):275-276. PubMed
10. Arora AS, Murray JA. Iatrogenic esophagitis. Curr Gastroenterol Rep . 20002(3):224-229. PubMed doi:10.1007/s11894-000-0065-1
11. Serck-Hanssen A, Stray N. Esophageal lesions induced by iron tablets. Tidsskr Nor Laegeforen . 1994114(18):2129-2131. PubMed
12. Eckstein RP, Symons P. Iron tablets cause histopathologically distinctive lesions in mucosal biopsies of the stomach and esophagus. Pathology . 199628(2):142-145. PubMed doi:10.1080/00313029600169763
13. Kaye P, Abdulla K, Wood J, et al. Iron-induced mucosal pathology of the upper gastrointestinal tract: a common finding in patients on oral iron therapy. Histopathology . 200853(3):311-317. PubMed doi:10.1111/j.1365-2559.2008.03081.x
14. Glenn SM, Parakh K. Education and imaging. Gastrointestinal: pill esophagitis. J Gastroenterol Hepatol . 200823(2):339. PubMed doi:10.1111/j.1440-1746.2007.05304.x
15. Wani AM, Shiekh AG, Hussain WM, et al. Fluoxetine-induced pill oesophagitis. BMJ Case Rep . 2011. PubMed doi:10.1136/bcr.09.2010.3333
16. Andrade C. Levothyroxine in psychiatry: issues related to absorption after oral dosing. J Clin Psychiatry . 201374(8):e744-e746.
Saturday, June 19, 2021
The Mighty St. Lawrence River
The bi-national St. Lawrence River drains more than a quarter of the Earth’s freshwater and is two-hundred and fifty feet at its deepest point. It flows through both the U.S. and Canada and includes the Great Lakes. It's one of the largest in the world, and its waters reaching deep into the North American continent. Thus, the St. Lawrence River—and the Seaway—is a vital geographic and economic waterway that is part of the Great Lakes system. The river connects the lakes to the Atlantic Ocean and provides important navigation for ocean-going vessels.
The river is about eight hundred miles long and drops two hundred twenty-six feet between Montreal, Canada and Lake Ontario. It includes the world’s largest estuary, and there are three primary regions:
• The freshwater river between Lake Ontario and Quebec City
• The St. Lawrence estuary from Quebec City to Anticosti Island
• The saltwater Gulf of the St. Lawrence that leads to the Atlantic Ocean.
Two years ago, I had the privilege of cruising from Boston to Quebec City. Sailing through the Gulf of the St. Lawrence and down to Quebec City, my husband and I enjoyed the beauty and wonder of this mighty river. But it was even more special for me since I wrote the true story of my ancestors taking this same path in my debut novel, The Fabric of Hope: An Irish Family Legacy.
Back in the 1850s, tens of thousands of Irish fled to countries such as America and Canada through the St. Lawrence River in famine ships, hoping for a better life. These countries and others welcomed them with open arms. But getting from Quebec City to the Thousand Islands Region was no easy task.
In the 1850s, they used a French batteau—a large canoe—to take passengers up the two-hundred and fifty feet of falls and rapids to get to the Upper St. Lawrence, home of the 1,864 Thousand Islands. In 1959, the St. Lawrence Seaway opened to bypass these dangerous waters and link the Great Lakes with the St. Lawrence River and the ocean through a series of canals, locks, and channels.
St. Lawrence Fish
Commercial fishing and pollution have depleted fishing, but conservation is helping balance the river, little by little. Salmon, herring, and sturgeon have been overfished, but sports fishermen—and women—still enjoy many stretches of the river famous for their small and largemouth bass, northern pike, carp, and muskellunge (a.k.a. muskies).
Animals of the St. Lawrence
About eighty-three land and aquatic mammals call the river and its gulf home, including the beluga whale. The river is also part of the Atlantic Flyway, where at least 400 species of birds, such as bald eagles, ospreys, and black terns, reside and migrate. During the early 1900s, the fox, beaver, mink, and muskrat were threatened by the fur industry, but most have come back to a healthy level.
More than 1,700 species of plants include the rare lady’s-slipper orchid. Springtime blooms beautiful, summer is splendid, and the autumn is epic. It truly is a lovely piece of the world.
What else would you like to know about the mighty St. Lawrence River? Leave your answer or comments on the post below and join me on the 19th for my next post.
About The Fabric of Hope: An Irish Family Legacy:
After struggling to accept the changes forced upon her, Margaret Hawkins and her family take a perilous journey on an 1851 immigrant ship to the New World, bringing with her an Irish family quilt she is making.
A hundred and sixty years later, her great granddaughter, Maggie, searches for the family quilt after her ex pawns it. But on their way to creating a family legacy, will these women find peace with the past and embrace hope for the future, or will they be imprisoned by fear and faithlessness?
Susan G Mathis is an international award-winning, multi-published author of stories set in the beautiful Thousand Islands, her childhood stomping ground in upstate NY. Susan has been published more than 20 times in full-length novels, novellas, and non-fiction books.
Her first two books of The Thousand Islands Gilded Age series, Devyn’s Dilemma and Katelyn’s Choice are available now, and she’s working on book three. The Fabric of Hope: An Irish Family Legacy, Christmas Charity, and Sara’s Surprise, and her newest, Reagan’s Reward, are also available. Susan’s books have won numerous awards, including two Illumination Book Awards, the American Fiction Award, the Indie Excellence Book Award, and the Literary Titan Book Award. Visit www.SusanGMathis.com for more.
We are headed towards the 75 th Anniversary of the Class in 2023. The implication is that the Swallow may be a bit of a post-WW2 sailing relic no longer having a valid role in the fast-changing world of sailboat racing. How wrong you would be! The catalyst for the initial growth and subsequent success was the 1948 Olympics – the ‘Austerity Games’ held at various London venues, and with the sailing events in Torbay. It didn’t just happen! As sailing emerged from the aftermath of conflict the forerunner of the RYA had decided that a new keelboat class was needed – the existing Dragon Class being deemed too large, ponderous and expensive, and other local keelboat classes unattractive for this purpose. The Committee tasked with coming up with the answer had the ‘fast forward’ impetus of the newly announced Olympics to create a keelboat of 200 sq ft sail area, light displacement that was ‘fast and lively but not freakish’ (!) that would be suitable for mass production. The first trials were held in a perishingly cold winter with a storm that wreaked havoc for the four prototypes on their moorings in Cowes. It was Tom Thorneycroft’s Toucan Too (the fore-runner of the Swallow which got the nod after a second weekend of trials (and much repair and modification work to all the boats in the intervening week). No-one quite knows how the design came to be called the Swallow! What stood out were the smooth lines, the relatively low freeboard and sparkling performance with greater lift from the bow sections than the Bembridge Redwing – another potential competitor and kindred design.
Time and the availability of suitable materials was fundamental to getting enough boats built in various locations around the world – the Netherlands, Germany, Sweden, Denmark and Canada amongst them. Wood was uniformly used although plastic had been considered but rejected at that point in order to achieve the minimum weight. The door was left open for other construction materials when sanctioned. The trials to select the UK entry had been closely won by Stewart Morris and David Bond and there was a similarly nail-biting end to the Olympic event itself – having made an (overly cautious!) start Swift climbed to be fourth and topple the Portuguese overnight leader – by 14 seconds – to claim the gold medal. Post-games IYRU shenanigans (nothing changes!) curiously resulted in the 5.5m and Finn replacing the Swallow. With the exception of the Finn it was probably a blessing in disguise (does any Olympic class really flourish world-wide?).
In those times those who had supported the Class dispersed to sail other boats at their home clubs and after a hiatus fleets became established in N Ireland (some 10 boats), Aldeburgh and at Bembridge, Seaview and Cowes on the Isle of Wight. The IoW fleets did not surprisingly sail together and in time withered but Fleets in Chichester Harbour – at Hayling and Itchenor emerged later, particularly when Sir Geoffrey Lowles brought Toucan Too to Itchenor and Swallow sailing became competitive, and fashionable and gained fleet status in 1951 whilst he was Commodore. In that era and despite the weakness of the IoW fleets 30 Swallows would attend Cowes Week – and were the single biggest class. The Itchenor fleet had risen to 20 boats and the Hayling one to 10 with alternating starts. From this point on Itchenor would gradually become the principal centre for Swallow sailing. The advent of GRP Swallows from 1974 onwards gave a new lease of life to the Class and an enthusiastic fleet – eventually of 9 boats had also become established at Aldeburgh. Several boats were able to retain the keel of an older wooden boat, and their sail number too, all hulls since save for one exquisite wooden example, have been of GRP in a move facilitated by Mike Bond who is still active in Buccaneer. Other recent builders include Porter Bros and Composite Craft in Cowes.
Initially there were some issues over the keel profiles of the new GRP boats but which were quickly resolved. Rig developments have been accommodated when appropriate as technology development allowed and when costs were acceptable. Thus we now have carbon spinnaker poles, a modestly re-profiled white sail plan (which now includes a mylar/pentex mainsail and ‘blade’ style jib). One enduring feature, unchanged from the very beginning, is the large 200 sq ft broad-shouldered spinnaker which gives considerable additional oomph offwind in breezier conditions. What we have now – and always have – is an exhilarating 2 or 3 person one-design keelboat with classically beautiful lines which inspire those who sail in them – and those who observe them too!
For those who would like to know more we recommend “The Swallows”, a history of the class up to 2002 written by Brian Russell and available from your class chairman.