Gulp: Adventures on the Alimentary Canal

Roach chronicles the dangerous phenomenon of death by constipation through historical medical cases and the controversial theory surrounding Elvis Presley’s demise. The chapter centers on museum specimens of abnormally enlarged colons, particularly those of two historical patients known only as J.W. and Mr. K., whose medical conditions transformed their organs into grotesque curiosities worthy of display.

J.W., who lived in the late 1800s, suffered from Hirschsprung’s disease, a condition where nerve development fails in part of the colon, preventing normal muscle contractions that move waste through the digestive system. This created a massive backup that stretched his colon to 28 inches in circumference. The condition so distorted his appearance that he worked in a Philadelphia freak show as “Balloon Man” before dying at age 29 while straining in a bathroom. Mr. K. experienced similar circumstances, dying during defecation with an equally enormous colon that doctors treated almost like a patient itself.

Roach connects these historical cases to Elvis Presley’s death, examining the theory proposed by his longtime physician, George Nichopoulos, that the singer died from complications related to severe constipation rather than drug overdose. According to this hypothesis, Presley had a colon two to three times normal size and died while performing the Valsalva maneuver—the straining action that occurs during difficult bowel movements. This maneuver can cause dangerous fluctuations in blood pressure and heart rhythm, potentially triggering fatal cardiac arrhythmia, especially in people with existing heart conditions.

The chapter examines how medical squeamishness about digestive disorders may have hindered research and public awareness. Roach traces historical treatments for severe constipation, from the genteel approach of 17th-century physician Thomas Sydenham, who prescribed kitten therapy and horseback riding, to more extreme interventions involving mercury ingestion, electrical stimulation, and surgical removal of healthy colons.

Through interviews with Nichopoulos and examination of medical literature, Roach demonstrates how constipation-related deaths occur more frequently than commonly recognized, particularly in hospital settings. The chapter ultimately argues that societal taboos surrounding bowel function may prevent important medical discussions and proper treatment of potentially life-threatening digestive conditions.

In this chapter, Roach explores the emerging field of fecal microbiota transplantation (FMT) by attending a themed party hosted by gastroenterologist Alexander Khoruts and by later observing an actual transplant procedure. The party, complete with colon-themed decorations and foods, introduced Roach to medical professionals who study gut bacteria and perform these life-saving transplants.

Roach explains that the human gut contains trillions of bacteria that play crucial roles in digestion, drug efficacy, and disease prevention. These microorganisms can determine whether certain foods benefit or harm individuals, and they may even influence behavior and dietary preferences. The bacterial composition in each person’s gut largely stems from their mother during birth and remains relatively stable throughout life.

The chapter focuses on fecal transplants as a treatment for Clostridium difficile (C. diff) infections, which can cause severe, sometimes fatal diarrhea. When antibiotics eliminate protective gut bacteria, C. diff can proliferate unchecked, particularly in patients with diverticulitis, where bacteria hide in colon pockets. Roach follows the entire transplant process, from donor selection through the laboratory preparation involving blenders and sieves, to the actual colonoscopy procedure.

Dr. Khoruts achieves a 93% success rate with these transplants, dramatically outperforming traditional antibiotic treatments. However, bureaucratic obstacles severely limit patient access to this effective therapy. Roach explains that regulatory bodies create lengthy delays over trivial concerns, while insurance companies lack billing codes for the procedure. Some desperate patients attempt dangerous home treatments with mixed results.

Roach critiques the medical establishment’s resistance to FMT despite its proven effectiveness and low cost. She suggests this resistance partly stems from pharmaceutical companies’ financial interests in ongoing treatments rather than cures. The chapter concludes with Roach’s reflection on the irony that humans are essentially sophisticated tubes designed around digestive systems, yet most people remain ignorant about their internal organs’ remarkable complexity and beauty.