“Chew your milk!” Jackson commanded the American public in a 1937 article in Hygeia. “Nearly everyone eats too fast for the good of his health. All food should be thoroughly masticated and insalivated. Even milk ought to be ‘chewed’; that is, it should be sipped and each sip should be rolled around the mouth so that it is mixed thoroughly with saliva before it is swallowed.” Who could take seriously this sort of border-patrolling of the body with its ridiculous injunction? Chewing liquids, I would think, might make a person more likely to choke than not.
But how does someone swallow that glass collar button, shawl pin, dental root canal reamer, brass atomizer tip, crucifix, cocklebur? How does a fence staple, rubber eraser, tag fastener, glass bead, shoe button, wristwatch, or pebble end up in someone’s stomach? Jackson’s answer to the question in his voluminous Diseases of the Air and Food Passages of Foreign-Body Origin is both lengthy and spare. In a word, Jackson explains, carelessness is the cause, in most cases, of a thing finding its way into a person’s windpipe or down his gullet. Who would have guessed that the “presence of a sharp-pointed piece of wire in a woman’s esophagus points to the carelessness of using an old broken egg-beater in making the custard pie, the swallowing of a piece of which constituted the accident in this case”? Then there is the “carelessness of having an inedible, insoluble foreign substance in the mouth” (DAFP, 22), or the “filthy method” of using the mouth to hold tools (DAFP, 72). Desperate to try to hold these things out of place in place, Jackson moved exasperatedly from unconvincing statistical deductions to an infinite, ungraspable array of causes, at the same time that he remained steadfast that carelessness was the primum mobile of humans’ swallowing of things. As a mockery of Jackson’s own “Be Careful!” admonitions, one fbdy in his collection stands out: item #2483 is a pin that bears the inscription “B-A-2-Way Looker Says Care Fu Lee” (see figure 3, page 7). If the pin’s inclusion here means that someone ate the message rather than heeded it, this could be considered the collection’s fbdy par excellence.
“If no one put into his mouth anything but food, foreign body accidents would be rare” (DAFP, 72). This simply isn’t true, as Jackson’s exhaustive documentation of any and everything finding its way into the mouth attests. If carelessness is set aside, perhaps another coherent set of causes can be brought in. Jackson suggested “personal factors, such as age, sex, occupation, and place of residence of the patient; failure of the patient’s normal protective mechanism; physical activities, expression of emotion, posture; dental, surgical and medical factors; and properties of the foreign body itself” (DAFP, 18). He concluded that “chicken bones are much more frequent as foreign bodies in women,” and “foreign bodies occur more frequently in the poor” who don’t enjoy the “watchful oversight of the well-to-do class” (DAFP, 19).
This analysis hardly amounts to a science and isn’t indulged for long before the assumption of carelessness once again creeps in, like a bane laced with responsibility, guilt, and the possibility of prevention; it moves across every page of Jackson’s prose until I begin to feel I’m reading a kind of Moby-Dick of the source of swallowed things, an insane compendium of postmodern proportions. It’s both sad and mildly comic to watch this little word by which Chevalier Jackson would like to contain orality in humans—“carelessness”—morph utterly out of control.
Throat cleared, he began again: “The almost infinite forms of carelessness may be grouped under a few heads” (note the struggle to contain “infinite” with “few”):
1. Carelessness in the preparation of food.
2. Carelessness in eating and drinking.
3. Carelessness in putting inedible substances in the mouth.
4. Carelessness of parents and nurses, and
5. (The wonderfully tautological) “carelessness in play.” (DAFP, 29)
Moving from the general to the specific case of carelessness, here’s a random sample of absurdist prophylactic rules:
It is carelessness to serve food containing fragments of nut shells, egg shell, oyster shells, crab shells, etc.
It is carelessness in the kitchen that permits containers and utensils to contribute fragments of egg-beaters, chips of enamel or china-ware, splinters of wood from flour or sugar barrels, solder from tin cans, etc.
Care should be taken, when cooking or serving food, to see that there are no loose pins or buttons in the waist that could fall into the food.
Hasty eating and insufficient mastication should be avoided as dangerous.
Chewing of pencils, toothpicks, grass, stalks, straw, etc., apart from general objections, is a source of foreign body accidents.
Veering away from carelessness, skirting it with chaotic glee, were the numerous other possible causes that Jackson was compelled to note. A person could ingest a foreign body just by “taking a deep breath to cough or sneeze,” which “can relax reflexes that keep things at bay” (DAFP, 20). Or by
Recumbency.
Vomiting.
Coughing.
Running and jumping.
Falling.
Anger. Dispute.
Excitement.
Sobbing. Crying.
Laughing and whistling. Note: “The combination of laughing, running and eating peanut candy” could be deadly (DAFP, 22).
Stertorous (i.e., heavy, deep, or noisy) breathing.
Drunkenness.
Sleep.
Unconsciousness . . .
. . . and the list goes on.
Watching Jackson try to answer the question of “how”—how did you swallow that, what was that doing in your mouth?—one glimpses a struggle so great that it led him to draw class divisions between the innocent and the guilty because, as it turns out, swallowed objects are never due to the carelessness of a doctor or dentist: “It does not appear from our records that an accident was due solely to carelessness on the part of a dentist or oral surgeon” (DAFP, 22), and when the spring-catch of a Robertson tonsil forceps is inspirited into a boy’s lung during a tonsil operation, “this was not the fault of either Dr. Robertson or the tonsillectomist” but the “fault of the workman who tempered the steel . . . the temper was not drawn to the point where it would bend before breaking” (DAFP, 24). Doctors can’t be careless because they are presumably full of care. Diseases of the Air and Food Passages is marked by exquisite tension between Jackson’s strenuous desire to prevent foreign-body ingestion and the fact that removal of foreign bodies from the air and food passageways provided him with a distinct and singular pleasure: “there is an indescribable pleasure created by the removal of a foreign body considered quite apart from all the collateral pleasures” (LCJ, 201). Without the masses’ carelessness, he would be out of a life’s jouissance. If bodies and their objects could be perfectly protected from one another, then Jackson wouldn’t be able to perform his wonders.
Emboldened to scientize the swallowing of objects as if it were a disease, intent on the achievement of a logical answer, Jackson was bound to arrive at zany conclusions when he headed a notebook with the words “Etiology: Race.” Having covered gender and class—women seem to swallow chicken bones more than men, the children of the poor are more fbdy-prone than the children of the rich—he ventured into the territory of eugenics and concluded that the Japanese are a superior race in this regard:
It would be to [sic] much too [sic] say that race, considered entirely apart from environment, is a factor in foreign body etiology; and yet some very interesting observations have been made. The eminent and skillful bronchoscopist, Prof. Ino Kubo tells me that though safety pins are much used in Japan, yet there has never been known a case of safety pin as a foreign body. Anyone who has watched the bright laughing faces of the beautiful children of Japan at play will be glad to know that they are immune to the temptation to put these dangerous things in their mouth; but the explanation is unknown. Possibly Japanese mothers have the good sense to avoid setting a bad example by putting safety pins in their own mouth.
Safety pins, whi
ch Jackson enjoyed calling “danger pins,” are tempting to the palate of the people of one nation state and not the other: therein lies a tale, but I’m not sure Jackson had the means at his disposal to tell it. So many shapes, sizes, and types of safety pins entered Jackson’s clinical domain that he kept a string of prototypical pins in a special place in the clinic. Jackson may not have wanted to be presented with yet another safety pin and the beguiling question of “how” that accompanied it, but as objects they came to take on a fetishistic aura; fellow bronchoscopist Emily van Loon reported that the string was always referred to as the Bronchoscopic Rosary (see figure 12). No doubt it yoked together a group of people by a bronchoscopic creed, dedicated to a higher purpose, who venerated the objects that they also found menacing.
Imagine this scenario: Sigmund Freud seeks out Chevalier Jackson as the best person to treat his throat cancer, and in exchange for his services, Freud helps Jackson with his PTSD—he listens to his dreams and helps him reform nightmares of childhood trauma. It’s an encounter that might have been nurturing or instructive in both directions, but the two depth specialists—one of the body, the other of the mind—never crossed paths. Consequently, the invention of the idea of an unconscious seems to have bypassed Jackson, who found no way to admit human psychology into his accounting of oral acts. Foreign-body ingestion is impossible to prevent not because of carelessness in humans but largely because of factors that Jackson seemed unable to allow into his schema—desire, drive, instinct, hunger, and love. Maybe I swallowed a button because I loved it or loved sucking it, or because it reminded me of a nipple, or maybe it ended up in my mouth accidentally on purpose. Chevalier Jackson could only read the mouth as a site of danger rather than pleasure, of utility rather than appetite. So focused on carelessness as cause, Jackson never considered that poor children might have swallowed objects more frequently not because they were the victims of careless caretakers or lacked self-control but because they were starving.
Fig. 12. The Bronchoscopic Rosary, a chain of safety pins representative of the range of prototypes a person might swallow or inhale. Chevalier Jackson Papers, Archives Center, National Museum of American History, Behring Center, Smithsonian Institution.
To be fair to Jackson, it’s important to acknowledge that he did at least nod in the direction of “hysterical swallowing,” and thus the possible admission of an unconscious, but he treated it as the anomalous instance of “voluntary swallowing” and paired it with “morbid” tendencies and suicide attempts (as in the case of the man who tried to end his life by swallowing a handful of tacks), even though hysterics weren’t necessarily trying to take their lives. Hysterics sometimes presented with the phenomenon of “intentional inspiration of a foreign body” or, just as often, the highly interesting (if only to an observer) “imaginary foreign body” (DAFP, 28). Jackson claimed to have experienced such cases but never described how an encounter with a hysterical patient might unfold. I imagine he would be a hysteric’s perfect interlocutor because, as Jackson made clear in his textbook, one of the things that distinguished him from his contemporary peers—in addition to his profound gifts, pioneering techniques, and skill—was the fact that he believed in the presence of an ingested foreign body in the first place. Much of Diseases of the Air and Food Passages of Foreign-Body Origin is taken up with photographs of emaciated children whose prolonged torment and, in many cases, deaths were caused by doctors’ unwillingness to suppose the presence of a foreign body to begin with. Realizing he had to convince people of the presence of an entity that is present though invisible offers another explanation as to why Jackson referred to his textbook as a kind of gospel and to himself as an evangelist.
The hysteric enters the examining room with the complaint of being invaded, of being full, of something being stuck. And Jackson, unlike the rest of the world, believes her because even if the Roentgen ray he’ll perform fails to reveal an object, and even if she goes so far as to let herself be invaded again, this time by his scope, there is something there, isn’t there? Even if it’s as simple as something she is trying to say and needs him to hear or something she wants him to acknowledge, if not remove.
Might it have been useful to have recorded the things hysterics claimed to have swallowed? Or really did swallow? Not voluntarily but against their will? Or wished to swallow? These items are hard to identify on Jackson’s 636-page grid. The only reference Chevalier Jackson makes to a hysterically fabricated foreign body in Diseases of the Air and Food Passages of Foreign-Body Origin appears to belong to a fairy tale of helpless maidens in search of princes in the mouths of toads: “Frogs and toads have been known to be inspirited when being held in the mouth; but all of our supposed cases of this kind proved to be conjurations of hysterical imagination” (DAFP, 36). He does cite a case of a woman who came to him with over “500 ordinary pins” in her stomach, and another who had “twenty-six large open safety pins entangled together so that they moved around the stomach as a single mass bristling with points. This massing was favored by a piece of string 4 meters long that the patient had swallowed separately” (DAFP, 173). But these cases appear under the heading “symptomatology” in order to make the point that foreign-body ingestion can often be symptomless while the object carries out its silent, destructive work. The woman with the pins in her stomach felt only “discomfort and slight pain.” For Jackson, the mystery of how to discern the presence of a symptomless foreign body is more pressing than how to explain its course of entry. No explanation of etiology appears.
People might swallow things as some sort of unconscious psychosocial protest for reasons that are no more evident to themselves than to the physician who attempts to treat their problem. Deliberate fbdy ingestion is considered “hysterical.” But people have swallowed all manner of things for sport and spectacle—from frogs and stones to swords and fire—and the annals of medicine are filled with peculiar cases of people swallowing live fish, the creature most apt to find its way into the human mouth, as though the fish felt most at home there. So long as we’re not experiencing the impaction of live fish inside our throats ourselves, we might find it freakishly entertaining to imagine one caught inside the body of another, but so long as Jackson is determined to domesticate a phenomenon that has wildly uncontrollable dimensions (i.e., foreign-body ingestion), we will never find discussions of fish-in-throat in his work.
In 1926, one of Jackson’s contemporaries documented as many accounts as he could find the world over of live fish stuck inside the human pharynx or trachea and presented his article to Jackson as a kind of gift. One can only imagine how Jackson received it. There’s not a single mother to blame in Gudger’s article, and Jackson is all about scolding negligent caretakers. Usually it’s the result of a fisherman putting a fish in his mouth while preparing his hook with bait, or it’s the effect of a failure to bite off the head of a fish as a method of killing it. On more than one occasion, the fish is found grasping the swallower’s uvula in its mouth. Or the fish is entirely stuck in an orifice, and the victim has to wait for it to die in situ, after which it is brought out in fragments. “On questioning the patient how the accident occurred, I was told that while he was swimming with his mouth open, the fish went in, and in an instant he felt something biting in his mouth.” Fish seem to go for the smoothly dark, wet, and cavernous interior of the human body as if to remind us that we’re all so many parts ocean. You have to picture the precarious human, he to whom things happen when he’s just trying to extend the possibilities of his limited physiology, such as “Simeon—, a native servant,” who, “while fishing in the shallow waters of the rice fields, attempted to kill with his teeth a fish that he had caught, and at the same time groping with his left hand to catch another.” In another case, an eel caught in a man’s throat could not even be extracted after the man died, and he “was buried with it protruding from his mouth.”
How does a person swallow that? From Jackson’s exhaustive lists, we can draw but one conclusion: that
being alive is the cause of foreign-body ingestion.
Consider (but isn’t it obvious?) that the stomach, the mouth, the lips, and the tongue aren’t neutral or even merely physiological entities, though they may seem no more than mechanical devices by this account. The words “saliva,” “salivate,” and “salacious” (lustful) appear to have something in common. D.W. Winnicott uses the phrase “mouth love” to describe primitive, ruthless love. One only has to experience even a temporary crush to know that the stomach is the body part most affected by love and longing. And what of stomachs so full of feeling there is room for nothing else, not even nourishment?
How do I love thee? Let me mouth the ways. I love you mouth to mouth. I need to be resuscitated mouth to mouth. Houdini’s wife delivered to him the means of his escape inside a kiss: a key, say, that he would only partly swallow and then regurgitate, and then set himself impossibly free. We talk about feeling our hearts in our throats, and of being choked up when overcome by emotion. In fairy tales the world over, a woman swallows something—leaves, flowers, almonds, icicles, sparks—and becomes pregnant as a result. Greek mythology has parents devouring their own children, sometimes knowingly, sometimes not.
Once upon a time, a woman who had been without romance for a time fell in love. She was spritelike and eccentric and the man she fell in love with was lithesome and exceedingly fair. The first meal that a lover serves to a beloved is always momentous even if it is entirely ignored, and this was no exception. It was Easter time, so the woman prepared lamb chops and mint jam and played the piano for the man to listen to before they dined. Following a few forkfuls of meat, the swain choked, and the couple spent the rest of the evening at a hospital emergency ward, where they concluded, in the course of an endoscopy, that an entirely unchewed piece of lamb sat on the esophageal shelf that serves as the stomach’s antechamber. Everyone joked that the man had choked on “the Lamb of God.”
Mary Cappello Page 8
