Mary Cappello

by Swallow: Foreign Bodies

  In 1952, Louis Clerf, one of Jackson’s students, who later worked at the Jefferson University bronchoscopic clinic, delivered the annual Thomas Dent Mütter lecture to the College of Physicians on the subject of foreign bodies. In his address, “Historical Aspects of Foreign Bodies in the Air and Food Passages,” Clerf put the case simply: foreign bodies are “always a source of human and dramatic as well as clinical interest.” Jackson’s struggle to keep the emphasis solely and entirely on the clinical interest of foreign bodies is something I want to understand, all the while knowing he wouldn’t want me messing with his things. In a letter dated February 28, 1924 (the year of the bequest), Jackson states the terms of his bequeathing his entire collection of foreign bodies from the air and food passages to the College of Physicians: “The gift would be without any stipulation except that the specimens and accompanying records should be accessible to all reputable graduates in medecine [sic] under such regulations as the College of Physicians, or its duly authorized representatives, may deem proper.” In one of many radio programs that Jackson appeared on in the 1930s, he repeated to the public, “The specimens and additional data are accessible to reputable members of the medical profession, for study, upon application to the Committee of the Mütter Museum, of which Dr. George H. Fetterolf is chairman.”

  Long before Jackson bequeathed his collection to the College of Physicians, however, he was in the habit of mounting his objects and kept what newspapermen of his day referred to as a “museum” in his clinic. (Jackson experienced newspapermen as the bane of his existence, especially when they latched onto the sensational aspects of a case and thereby, to his mind, occluded possibilities for prevention and instruction.) One journalist begins his essay, “Dr. Jackson Looked Down Human Wells,” with what sounds like a fairy-tale fact: “He had to work hard because people were always swallowing things the wrong way, or swallowing things that shouldn’t be swallowed.” Then he continues: “At his clinic, Dr. Jackson had a museum of curios taken from human throats. The museum included teaspoons and tablespoons, handsome brooches, gold watches, and other imperishable items” (see figure 4).

  “Knickknacks.” “Whatnots.” That’s what another reporter calls them in a January 26, 1924, article for the Pottstown News that interestingly foregrounds the fact of Jackson’s collection over and against his act of saving a young boy. Titled “Tack Added to Dr. Jackson’s Exhibit,” the article begins:

  Dr. Chevalier Jackson today added the 1265th specimen to his foreign body exhibit in the bronchoscopic clinic at Jefferson Hospital. It was the carpet tack taken from the lung of eight-months-old Cletus Moore of St. Louis.... Mounted on a white card, the tack went to join hundreds of similar exhibits collected at Jefferson Hospital during 30 years. Cletus’ tack seemed shiny and new beside the others. It was inside his lung four weeks before Dr. Jackson removed it in an operation that took four and a half minutes.

  Jackson was rarely paid by his patients, most of whom were “charity cases”; his only request was that he be allowed to keep what he called the “intruder” or the “fbdy.” Trophies, tokens, part-bodies, petits objets, Things. Found objects, literally so, and as such, treated by their contemporary interlocutors as just that: tantalizing remainders, to make of what we will.

  Fig. 4. Chevalier Jackson posed with bronchoscope and foreign bodies. Chevalier Jackson Papers, Archives Center, National Museum of American History, Behring Center, Smithsonian Institution.

  Chevalier Jackson, the man with a first name that sounds like a last name and vice versa, whose middle initial is Q for Quixote (it’s true)—the first time I set eyes on his collection, I pictured a fellow with a top hat, a tight-fitting jacket, a tiny upward-turning moustache, and the whip of a lion tamer.

  “The Great Chevalier.” So he was hailed by reporters, an appellation that might lead us to place him alongside the Bearded Lady, the World’s Tallest Man, and the Tocci Brothers. Chevalier Jackson was as curious as his things are. One reporter (meaning, I think, to describe his skill as “superhuman”) used the word “inhuman,” as though, unconsciously, she regarded his rare and assiduous practice as lending him an other-than-human excrescence, an unsympathetic mantle, a cruel aversion to the norm. In the course of his lifetime, newspaper accounts called him a “saint,” a “wizard,” a “magician,” and a “modern miracle man,” none of which rhymed with the practicality, scientism, and exactitude with which he preferred to ally his practice, if not his preoccupations. (He found such forms of reference to himself “nauseating.”) But the fact of the matter is that a great many of the displays in the Mütter Museum, and swallowed objects especially, tread a fine line between the didactic and the entertaining, the spectacular and the edifying, the odd and the commonplace, the freakish and the pathological, the circus and the medical amphitheater. Jackson’s curriculum vitae is impressive, awe-inspiring even, and to bring the singular nature of his achievement and gifts to light is part of what drives my own interest in giving his story back to the world. But he was also monomaniacal, oddly ascetic, and extravagant: an eccentric genius, a collector, a maker of a cabinet of curiosities that is also a non-narrative assemblage along the order of a modernist work of art housed in a museum of pathological specimens.

  Probably no one would like to admit that medicine’s earliest endoscopists learned techniques from Barnum & Bailey sword swallowers, but in the annals of medical history, we find discussions of how German professors Alfred Kirstein and Gustav Killian, whose lectures Jackson observed before developing his esophagoscope and his bronchoscope, derived their methods from sword swallowers, and that Jackson “perfected [in others] the circus sword-swallowers’ technique of throwing back the head so far, that the mouth, throat and windpipe or gullet form a straight channel through which a straight metal tube can be slipped” (“Bronchoscopist,” Time, June 1, 1936). Clerf confirmed the link in his 1952 address: “Passage of a tube into the esophagus or stomach was inspired by the sword swallowers.”

  Where slipping a sword into the gullet is concerned, some people like to watch, some like to do it, and others like to imitate it in the form of science. The connection was never lost on Jackson, and he exploited the circus as metaphor in startling and macabre ways. In a 1922 article for the Annals of Surgery, “New Mechanical Problems in the Bronchoscopic Extraction of Foreign Bodies from the Lungs and Oesophagus,” he conjured a delightful link when he wrote, “The forceps are, mechanically speaking, a prolongation of the fingers. Their necessarily great length makes their use somewhat in the nature of walking on stilts. Special practice is necessary to acquire perfect control.” In one of his numerous textbooks, Diseases of the Nose, Throat and Ear, he explained how he taught children whose throats had closed from the ingestion of lye to swallow a tube so that the esophagus, in time, might expand again. (Lye burns the esophagus and the scar tissue that follows can cause it to narrow.) The enticement toward cure was achieved by encouraging the children to feel that they were circus performers. “The stricture has to develop a lumen of normal size again,” he explained;

  a patient of this age (five) can then be taught to swallow a stomach tube of about this size. He is cautioned against pushing on the tube. He must be led to be proud of this “sword swallowing act,” which inspires awe in other children witnessing it. Doing this once a week will keep the lumen open, so that anything can be swallowed, and the lumen of the stricture gets larger and larger as the child grows. The normal segment yields and enlarges until the cicatricial segment becomes a scar on the sidewall. Although a five-year-old patient has been taken for illustration, children as young as two years can be taught the swallowing act.

  And yet. The admission of play, of beauty, or of the imagination, the acknowledgment of desire or indulgence of appetite, is the exception rather than the rule in the life and work of our exquisite cabinet-maker. “In medical matters as in all affairs of life, I am an actualist.” He underscored the final word in his notebook and paraphrased himself for a commencement address: “I
never read fiction. I never could get interested in a story that originated in the writer’s brain. In medicine I want clinical facts not theories.”

  Jackson was a self-pronounced abstainer—from cigarettes, from alcohol, even from food. His particular formulation of “prevention” came nearer to self-protection than self-care. Denial became his trademark; anti-risk, his brand. To eat a peanut kernel is to expose yourself to the threat of sudden death; to cheer your team on at a football game is a form of willful self-harm because it damages the larynx (on this score, Jackson admitted he might be perceived as a “wet blanket”). Accidental ingestion of foreign bodies is within our control, according to Jackson—if only we would be more vigilant, damn it. Just as he could not admit a degree of reverie or daydream into the etiology of swallowed things, so he was loath to let the objects he retrieved from bodies be afterward promiscuous. The objects in Jackson’s collection mustn’t be allowed any waywardness; one senses that he needed for them to do the right kind of work—to serve as utilitarian prototypes for practitioners and exert a disciplinary force for viewers. The collection must be definitive rather than suggestive.

  Like so many Kunstkammers, or cabinets of curiosity, Jackson’s treasure trove is accompanied by a catalog meant to help it make a kind of sense.

  First, collect: if every Thing is gathered, nothing can be missing. This is what it means to hoard.

  Then, catalog: if every Thing is identified, then nothing is not accounted for.

  But this is not the case. No drawer is bounded on all sides. The introduction of a drawer invites the idea of other drawers nestled within it, the secreted inside the secret, the letter inside the word inside the envelope.

  Jackson’s cabinet is so full and so scrupulously documented, held in place with an encyclopedic girth of information, and yet so much is left out of his account: the bodies the objects once inhabited; the lives of their onetime owners; the things he knows about the cases that he doesn’t tell, especially if the story isn’t one of accident but of aggression. Violence. Ingestions, willful or forced. A new category for the circus to consider: the freak accident, when accidents within our normal range of comprehension gain an uncanny protuberance, when the laws of nature are upturned, when sequence is interrupted by confluence. There is an illogical fateful-ness with which so many of these objects are imbued.

  In 2007, an eighty-three-year-old woman named Margaret Derryberry inquired at the Mütter Museum about the pin she aspirated when she was nine years old. Why, we might ask, would she want it, and what would be the draw of the pin to a person reaching the end of her life? A fbdy, once lodged, is part body, is it not? Each enjoyed an intimate, itinerant strangeness with its host. An in-animacy inhering, adhering, and afterward removed—but not forgotten or so easily dispensed with or disposed of. I don’t think we can assume that their victims didn’t afterward want their Things, that they wouldn’t have wished to keep the souvenirs of their near-deaths, that an unspoken tension doesn’t undergird the collection: between Jackson’s relation to these objects and those to whom they, in another sense, belonged.

  The story of medicine is a story of patients as well as physician-operators: what Jackson left out of his grid was a matter of personal predilection—what his particular personality would not allow itself (especially the desire of the other, the human appetite)—and a matter of what medical discourse cannot afford to admit, what refuses to be contained, what is rife with multiple beginnings and unpredictable endings: the narratives, even stranger than the fiction that Jackson eschews, of psyche and soma, of sociology and place, of a nearly infinite set of any being’s conditions of possibility and the terms of its crisis. Foreign bodies are haunted bodies. Memento mori, half-finished tombstones missing their owner’s names. Dead-live matter. Does every human being have one of these things to show for himself in his life’s hereafter? As if to say, here is what is left of me, what’s left of me is that-which-was-once-within-me.

  It has been said of collections generally that the whole overpowers the narratives accompanying each object in the singular. The Chevalier Jackson Collection of swallowed and aspirated things doesn’t exactly erase or supplant such stories—stories that are, in every sense, original—but hints evocatively at their absence. If the collection is haunted, then to restore the collection’s missing parts, to call after its ghosts and allow them to materialize, is not to complete the collection but to open it. What might happen to the collection if we let narrative and desire back in? We might begin to choke if we think too much about the precarious proximity of trachea to esophagus, the airway and the foodway, in humans. We might start to notice that certain flowers have throats, and be glad that, unlike squid, our esophagi aren’t collapsed inside of our brains. We might have to ask why we say we swallow our pride and not our envy, anger, or greed. We might be drawn inside a psychic bottleneck that holds that swallowing is just another name for incorporation or come to terms with our own indigestible thoughts. We might want to consider the consequences of our imaginations, like our mouths, being open to preemptive intrusion from the day we are born. We might want to contemplate our own fascination with found objects, the object world, objects lost and found, and to remember that “puzzle” can, as a verb, mean both to confuse and to solve. We might pause to note that “scarf down,” “wolf down,” and “inhale” are synonyms for a certain kind of consumption in which eating is reduced to swallowing.

  Consider the physiology by which a body swallows. Swallowing is an only partly voluntary and, by any estimation, a highly complex activity reliant on a series of interdependencies and even blockages. In order for food and drink, for example, not to go into the trachea, the vocal cords actually close over it to temporarily seal it off. (It is no doubt for this reason that one is advised not to try to eat and talk at the same time). Simultaneously, the larynx rises up to help direct the material toward the esophagus. Last but not least, a flap of cartilage, the epiglottis, closes over the trachea to further shield the airway.

  Consider the stomach’s lesser or greater curvature in embryo; imagine that moment at which it rotates therein. Is there anything more tympanic, more like a concerto, than the combination of involuntary contractions and transport, rising and falling, protection, and preparation that is eating? Or how about the interplay of complementary movements by which inhibition, elevation, approximation, and deflection make it possible to breathe, to eat? There’s a poetry to the language of the swallow implicit in the names for things. The stomach is misnamed—the “proper” name is “ventricle.” Or tummy. Belly. Bread basket. A swallow is a deep hole opening in the earth, a yawning gulf, a capacity, an inclination. It’s a river losing itself in another. Gobbling. It’s to take completely into oneself. The stomach could steal the place of the heart as a seat of affection so that it’s not I heart you, but I stomach you. I feel you inside me. I love you, I carry you. “Bronchi” doesn’t really mean breathing tubes. Or trees. The word derives from the word for shower or wet or pour, because originally it was believed that the bronchi carried liquids to the stomach. How is one thing brought to another? Wherefore this dipping, this swooping from place to place? How do we get there? Sphincters above and below play significant roles in the human swallow. The upper esophageal sphincter, it is thought, contracts during inhalation to prevent air from entering the foodway. When we’re nervous, it can contract too much. Does the brain efface the body’s built-in protective mechanism? The lower esophageal sphincter prevents stomach acids from moving upward into the esophagus and marring it. It too can malfunction when we’re beset by mental gripping. Afferent fibers motivate the brain’s swallow center. The lips prevent drooling.

  “Right now he’s practicing swallowing,” my friend who is eight months pregnant confidently reports, “and he opened his eyes at twenty-eight weeks.” She read about this more or less consistent trajectory in one of many guidebooks that was walking her through the mysteries of her first pregnancy and, by extension, through the labyrinth tha
t was the heart of “human development.” While she was moved by the thought of the moment at which the eyes first glide open—and I, too, was fascinated by the thought of sight sans cognition—I couldn’t help but be equally intrigued by what it meant to say the fetus was “practicing swallowing” without being able to put food into its mouth. Was this ur-contraction of an as-yet-to-be-formed digestive system a prelude to the sucking that would coax him toward nourishment, that was a preamble to biting, which was a prefigurer of speech? Or was the earliest swallow all about the tongue as an eagerly developing muscle detached from licks and tastes? We practice swallowing without a tutor inside the womb; once out, we learn to use our tongues in practical ways so as to take in food and nourishment, to swallow and to eat. During our earliest years, we reserve sticking out our tongues for protest and invective.

  In his 1989 essay “The Anatomy and Physiology of Dysphagia” (difficulty swallowing), the contemporary gastroenterologist Dr. Peter J. Kahrilas begins by noting how essential swallowing is to the human organism: “Swallowing is an extremely primitive behavior, so basic to our existence that we barely take note of it.” “Basic” must not be confused with “simple,” however, and if a bodily process escapes our notice, this doesn’t mean that it is easily comprehended. Dr. Kahrilas understands the baffling intricacies of the human swallow response and its attendant dysfunctions better than most of us, but I am moved by his reminder that we each remain humble in their midst: “In the process of analyzing the sequence of events that allows for ingested material to be transferred from the oral cavity to the stomach,” he writes, “it becomes clear that there are significant gaps in our understanding of many of the steps, and what seems on the surface a simple action is actually one of almost unlimited complexity.”