At the center of his black canvases, he mounted a tondo, a lambent perfect circle; in lieu of an obscured constellation, he drew an orb rimmed in ocher or a brighter shade of gold inside of which throbbed the color made possible by an endoscopic view. If his environment was without natural light, he would seek out light by turning inward, he would insist a light into the unlit recesses of the human body. Did you know that the throat is a bat-shaped cavern bisected by a white V for vocal cords? (See figure 7.) Or that the brownish-pink lumen that is the overture to the normal stomach lodges inside the darkness like a half-shut eye?
The brown clots and white striations of primary pernicious anemia rage like an eye looking back on itself, lopsided inside its socket. A white-and-pink pinwheel radiates out from a disease cluster’s exuberant growths, abundant as caviar: they will encroach, occlude, and fatally seal up an entryway if not removed. Is that an egg floating sunny side up across the night sky? His drawing (see figure 8) insists it’s the protruding head of a collar button caught inside the puckered fold of an inner alleyway—the mouth inside a mouth inside a mouth that is the human body.
Fig. 7. Chevalier Jackson chalk/pastel drawing of a diseased larynx as seen through his scope. Donated to the Mütter Museum by Arlene Maloney. Collection of the Mütter Museum, The College of Physicians of Philadelphia.
Remember Chevalier Jackson? He’s the person who considered a golf links a perfect place for sketching cloud patterns and the bright spots of colored sports clothes but not for playing golf. Chevalier Jackson? He’s the guy responsible for something as simple and persistent as replacing the customary white linens with green in the operating room, a color chosen for the fact that it doesn’t reflect glare.
Three hues dominate his life’s initial course: the gray pallor of diphtheria, the black-and-blue of violence, the blood on the matted fur of abused animals. There was a childhood hiding place for fleeing from bullies—a cemetery where cherry trees admitted little daylight and overhung the tumbled tombstones. Amid old bones in dark corners, he hid out, longing for licorice and imagining the cherry trees having sprung from the cherry pits swallowed by the once-living inmates: “My conception was that the trees grew from sprouting of cherry stones swallowed before death” (LCJ, 28). There were ineffective red rubber wheels on a pair of skates replaced with sleek nutmeg-colored rollers made of dogwood. Later, there was a green tin tubular box purchased for a dollar, a flute to hold his medical diploma.
Fig. 8. Chevalier Jackson chalk/pastel drawing of a collar button stuck in the esophagus. Donated to the Mütter Museum by Arlene Maloney. Collection of the Mütter Museum, The College of Physicians of Philadelphia.
The suddenness of vermilion, his own blood, coughed into a handkerchief at a medical meeting that he didn’t feel comfortable at in the first place and didn’t enjoy going to, with or without TB: this is how he experienced his second tubercular attack.
Dainty azure blue: the color of the cuffs and lapel that distinguish his compulsory white lab coat.
A judicious choice of parchment: yellow manila paper if he was writing indoors; green-tinted paper outdoors, again to lessen the glare.
What was common practice for him was regarded as highly unusual by others in his profession: an emphasis on teamwork in the operating theater; a habit of treating nurses as his equals; advocating for women physicians; and his generosity toward his assistants, a trait he was excoriated for at length by his peers. Jackson said that what distinguished his treatment of assistants from that of the other leading medical men of his day was that he considered them as his pupils, whereas other doctors thought of them as aides. He was training them to become bronchoscopists in their own right rather than conscripting them to the diminutive role of helper. Time and again, he would publicly credit an assistant with the design of an instrument that was his own. When a student would present the results of Jackson’s research as though the student was its author, Jackson claimed to have succeeded. Plagiarism, he said, was the highest form of flattery. Whether he really believed this is questionable—in the National Library of Medicine, an entire folder is given over to articles that Jackson angrily marked as plagiarized from him. He appears to have struggled with the idea of a personal versus a communal legacy to such an extent that his self-effacement sometimes seemed simply a cover for its flip side, self-aggrandizement. Laboring under the desire to be remembered—and who doesn’t want to be remembered, to exceed one’s lifespan on the planet, to endure?—he seems to have deflected what would otherwise feel like narcissism onto the idea of a greater good, a higher purpose, a cause of evangelical proportion.
Either he exerted a humility that was laced with egotism of the highest order, or he wished to be not simply a memorable sort of practitioner but a founder of a discourse, like Jesus or Freud. This is nowhere more apparent than in what came famously to be known as the Five Chairs—the positions at five different medical schools in Philadelphia that Jackson held more or less simultaneously. He puts the case powerfully in his Life: “No one anywhere in the world has ever before created, nor simultaneously filled, nor given away, five medical collegiate chairs” (LCJ, 207). After successfully establishing a clinic at Jefferson Hospital, he opened one at the University of Pennsylvania, then another at Graduate Hospital. Following this, he established a clinic at Temple University and later at the Woman’s Medical College, where he also served as president from 1935 to 1941. The institutions he was affiliated with wanted him strictly for themselves, so he remained affiliated with each even when he left it for yet another place. He was an iconoclast who didn’t think a child should die if she wasn’t able to find the sole clinic where bronchoscopy was practiced, nor did he think a student should be bound to a particular institution in order to learn a specialty; he believed no one institution should have a monopoly on the field. But the language he used to explain his five chairs did make him sound just a little nutty: a self-described “evangelist,” he needed to spread “the gospel of safe bronchoscopy,” and he regarded future practitioners as “disciples.” He referred to the talk he would regularly give his patients to relax them as the “sermon on relaxation” (DAFP, 184).
I am not a follower of Chevalier Jackson, but in writing this book I sort of feel like his channeler, his chronicler, his poet friend and scribe. Still, over and against my inscriptions, the most enduring memorial to his person and to his work is the memory box he made of swallowed things. A labor of love and a form of resplendent monomania, a sign of an at-once demonic and deeply caring relationship to the world.
It requires only that one read one of his lengthy essays, often painstakingly illustrated with his detailed drawings, to understand that Jackson studied down to each infinitesimal detail the nature of the nooks and crannies that constitute the tissue in our throats and chest, and then he studied, even more meticulously, the peculiarity of each and every type of object that might get caught. He would chart and map and attempt to distinguish the types of metals a body could consume and speculate about the differing effects on the body of an ingested item made of iron—cast, wrought, or malleable; copper—pure (practically) or alloyed with tin or lead; gold—solid or filled; brass—lacquered or nickel plated; steel; tin; or antimony (DAFP, 80). An early and curious discovery of his bronchoscopic practice was the observation he made in an interview for Energine Newsreel in 1936 “that a sharp, jaggy tack or pin, in a bronchus, cannot be felt by the patient; it produces no sensation whatever, and for a time, very little disturbance. Whereas a peanut kernel, a bean, pea, grain of corn, a head of grass, a watermelon seed, orange pit, or any other vegetal substance sets up quickly a violent reaction, and a severe, acute illness.”
Each and every new foreign body posed a unique engineering problem to him, and this is really where his pioneering work becomes awesome and mind-boggling. He went at each bit of peanut kernel stuck in a trachea, each safety pin in a stomach, each jack in a thorax, as a newly challenging Gordian knot, each solution carefully described in the many boo
ks and articles he wrote in the course of his very long life. But what constituted a solution? Nothing as simple as “turn left, then right, then pull.” Each foreign body posed a unique mechanical problem, and one in which a human life was a stake.
Did Jackson’s fastidious and studious techniques become “common practice” among endoscopists? I don’t think so. I think there was only one Chevalier Jackson, only one man who studied each particle of the material world, each of the world’s bite-size objects down to its constituent parts, its tendencies in interacting with human tissue, and the mechanical movements of multiple instruments—tiny forceps inserted through a narrow tube into the mouth—required by each situation of a foreign body lodged, every one unique. When three-year-old Kelvin Arthur Rogers traveled nine thousand miles from Australia to Philadelphia in 1936 to have Chevalier Jackson remove a nail from his lung with the aid of a bronchoscope, two readers wrote the Philadelphia Bulletin to ask: “ ‘Why isn’t there more than one bronchoscope in the world to take pins out of children?’ The answer: there are thousands of bronchoscopes, straight, hollow metal tubes with a light at the tip for looking down gullets, windpipes and lungs. There are nearly 2,000 physicians trained personally by Dr. Jackson in use of the bronchoscope. And there’s Chevalier Jackson.”
In the corner of a life’s work that can never be completed, each of us records a signature, read or not, legible or not, notable. Jackson’s signature, a trace worth returning to again and again, is the seriously beautiful, breathtaking description, recounted in numerous places, of the initial feeling of “going inside,” first with the esophagoscope, and eventually with the bronchoscope. How many doctors or even poets can find a language for the body out of bounds, our invisible interiors, distinct from a clinical vocabulary of Greek or Latin? The act of endoscopy is a little more profound than feeling with a finger for a pulse, and he recounts the act with reverence for the passage of sensation from one body to another, the passage of a rigid instrument into intolerant viscera, the passage of removal of a fbdy across a dangerously delicate crevasse:
All of this system of working had been developed with the esophagoscope. It remained, however, to adapt methods to the anatomically and physiologically different passages. The esophagus is a soft, elastic, collapsed, baglike tube full of wrinkles and folds; the tracheobronchial tree stands open by reason of its rings of cartilage. The bronchi enlarge and elongate at each inspiration, diminish and shorten during expiration. The heart at each beat dinges in the bronchial wall or pushes the whole bronchial tube sidewise; the thumping is transmitted to the fingers holding the inserted bronchoscope. One gets the impression of being in the midst of the machinery of life itself. In a baby the obvious delicacy of life’s constantly moving machinery is appalling. To work in such surroundings through a tube not much larger than a straw to manipulate a safety-pin, for example, is daunting to the utmost degree. Fully to comprehend this, it must be realized that “safety” of such pins applies only to location in clothing and even then only when closed. In the bronchi, they are usually open, the sharp point is upward and being forced by the spring into the bronchial wall. Moreover that delicate wall is beset with catchy ridges. (LCJ, 118)
How long is memory? Even and especially a bronchoscope has its limits, it cannot reach and reach and reach, it has to know where it begins and the body ends. We could remember Jackson for his aphorisms, pithy one-liners, like slogans that incorporate him, or recall him with each articulation of the eponyms that survive him, like Jackson’s position (the position of the head for intubation), Jackson’s safety triangle (a precisely defined anatomical area bounded by the lower end of the thyroid cartilage), Jackson’s sign (a particular wheeze that can be heard in cases of foreign body in the trachea or bronchus), and the Jackson tube.
What shall we remember him for?
For having designed special peanut forceps and for solving “the problem of the thumb tack?” (See figure 9.)
What’s more important: what the man did or what the man collected?
A bird lands on a piece of china. Its plump head, its green and yellow body, hover above dogwood blossoms and rose blooms in a setting too exotic to be real. Jackson subsisted at numerous points in his early life by decorating china and painting lampshades. Imagine someone somewhere lifting one of his teacups to their mouths, not knowing that his hand had graced it, not being able to imagine the distance traversed between teacup and life’s work, the import of this hand-painted object as a means to an end. Picture someone raising the cup to her lips and swallowing.
Fbdy #C804, Case #3268, X-rays #48451C and #48460C: The Case of Andrew C.
Chevalier Jackson’s extraordinary skill and the humble respect he had for the lives of his patients are something that’s timeless, and needs to be remembered.... The legacy of a physician can be measured by the recollection of his patients.
—V. ALIN BOTOMAN, MD, FACG, FACP
Fig. 9. The problem of the thumb tack as illustrated and explained in Chevalier Jackson’s “New Mechanical Problems in the Bronchoscopic Extraction of Foreign Bodies from the Lungs and Esophagus,” Transactions of the American Laryngological, Rhinological, and Otolaryngological Society 27 (1921). Courtesy of Thomas Jefferson University, Archives and Special Collections.
It’s possible to feel the past in a way that we can never know the present. Time ripens inside objects: scents don’t dissipate but penetrate more deeply into the folds of a hundred-year-old letter. A patch of time gains a voice and a step inside the archive. No magnifier is needed; in fact, from the distance of my present turned in the direction of Jackson’s past, each seemingly inconsequential and mundane detail writes itself as the center upon which a life depended, the object around which verbs and adjectives cluster, the boisterous kernel of what remains.
In a daybook calendar devoid of annotations, a phrase suddenly appears on March 28, 1886: “impatient but confident.” It’s his way of containing what he knows about himself but doesn’t dare announce in public: that he has done what he needed to pass all of his exams. He’s really still a boy writing letters to his family about a rare day off from schoolwork. He goes to the zoo alone and imagines the large seal he sees there to be the same he saw with his father when he was small: “it is very tame, came upon the bank and slept. The Beavers were very amused swimming after apples, the prairie dogs come up and eat out of your hand.” He goes to Fairmount Park and tries to bring his family with him to the glens and shady springs that tempt this boy who is otherwise always driven, always moving, to linger. With his sentences as conveyance, he takes them to its river with the unpronounceable name: Schuylkill. He eats catfish and waffles at Strawberry Mansion, coffee, steamed oysters, crackers, and pickled cabbage. “Whoops. Is that the way you spell it?” he asks in a letter from 1886. “I cannot find the word ‘pariphernalia’ in the dictionary,” he notes in a letter for 1884. He is anxious about the skull he has asked one of his brothers to send him through the mail—once dirtied, it can never be cleaned, and he wants to be certain of its proper handling. He attends and even enjoys a Spiritualist performance. “In the evening we went to hear Frank Baxter lecture at the spiritualist Hall corner of 8 and Spring Garden. He gave names and tests which were recognized by the audience it was very gratifying to see some old men and woman speak out and corroborate what spirit said. They sang some beautiful gospel songs ‘We shall Meet by the River.’ ‘We come with the Roses.’”
Another bundle of letters in the Thomas Jefferson University archive shows him hoping and expecting his family to travel to Philadelphia to attend his medical school graduation. The rise and fall of enthusiasm, finally checked by a stoic rationalization, is sad to watch, and all the more poignant in light of what he will go on to achieve: “Am just as well satisfied that no one is coming on as the commencement amounts to little more than red tape. To come all the way for it alone would not be a very good investment.” Instead of their company, he will ask his father to send a twenty-six-inch valise, a suitcase big enou
gh to accommodate the length of the tube that contains his diploma as he looks toward embarking, though penniless, for England, Germany, and France.
In 1916, on the horizon of the reopening of his career in Philadelphia, he receives fifteen quail from the father of a patient in North Carolina. He sends his brother maps of the night sky; Alice fulfills her mother-in-law’s requests for essence of peppermint and wintergreen. It’s impossible to speed through an archive, partly because handwriting slows an eye down, but by the time I arrive at the 1930s, I’m struck by how the ethic of medicine remains marked by what feels like an even more distant past: imagine doctors writing their patients five-page single-spaced letters detailing their assessment of the state of the patient’s health, letters complete with recipes, like “lay the potatoes and cabbage atop the onions to simmer,” saying that this will help to soothe what’s wrong.
The archivist’s name is Michael Angelo. (My name if I were to translate it into English is Mary Hat.) Michael Angelo introduces me to a gastroenterologist named Dr. Botoman, who is also carrying out research on Chevalier Jackson, inspired by an encounter with a man who had been treated by Jackson as a child in 1935. I don’t fabricate the names of people who enter and exit a Jacksonian theater space. I’m writing nonfiction, for god’s sake. Michael Angelo. V. Alin Botoman. Mary Hat. The names are real, and I love them at the same time for how they de-realize us by making us players in a drama none of us can author, in which a Renaissance artist supplies materials for a Victorian Sherlock Holmes and his inimitable side-kick. Botoman tells me that he removes foreign bodies from people’s stomachs and has never had the desire to “keep” the object. But he does recall counting the change he retrieved from one person’s gullet: exactly $7.25.
Mary Cappello Page 5
