The song tells the story of an old woman who swallowed increasingly large animals, each to catch the previously swallowed animal. There are many variations of phrasing in the lyrics, especially for the description of swallowing each animal. The spider and fly are described in each verse except the last, but the other animals are only described when they are introduced. The joke of the song comes from the fact that the woman clearly should have died after swallowing the bird, but manages to swallow even more animals of ridiculous sizes with no problem and survives, and yet she suddenly dies after swallowing a horse.
In some versions, "perhaps she'll die" is replaced with "don't ask me why." Also, "she died of course" is replaced with "of course, of course, she swallowed a horse," leading to yet another cumulative verse that ends the tale.
The song was used for an animated cartoon sung by Burl Ives. Ives's version included an extra verse, involving a pig, following that involving the goat and preceding that involving the cow.
The song's lyrics were used as the text of a children's book by Simms Taback. A video version of the song by the publisher was sung by Cyndi Lauper. Both these versions also feature the animals and the artist talking. A cow stands in the middle of one of the pages surrounded by flowers, a carton of milk, a Hersheymilkchocolate bar, some different types of cheese, a bar of butter and containers of cream cheese and sour cream. So the famous moral is "never swallow a horse".
The song's title is shared with a book by children's illustrator, Pam Adams. (ISBN 0-85953-727-7)
An Arthur episode is called "Emily swallows a horse," in which the song is used as an analogy for the increasingly complex and incredible lies that the character must use to cover her original falsehood.
The lyrics form part of the theme song for the popular children's show Round the Twist.
The Bill Nye the Science Guy episode "Food Web" featured a segment called "Uncle Fran's Playhouse" which featured part of this song.
One of Russell Bates's rejected scripts for Star Trek: The Animated Series, "The Patient Parasites," when it was finally published in Star Trek: The New Voyages 2, included the song's two earliest verses, those involving the fly and the spider in that order, in the "tag," or "epilogue," of the story.
^"Songs with Pictures" by M.B.K., Chicago Daily Tribune, November 12, 1961, page E34. (Reviewing a children's picture book, I Know an Old Lady illustrated by Abner Graboff of the music and lyrics of the song)