Mary Cappello

by Swallow: Foreign Bodies

  Approaching the foreign body collection through the door of presumably tantalizing -ests and mosts is more terrifying than fascinating in this way: doing so requires us to face not that which cannot be imagined but that which we do not want to imagine. Hidden acts of violence, peculiar in form and intent, lurk in Jackson’s most difficult cases, and the question is whether we can account for the acts in which the foreign bodies originate or if, like Jackson, we find ourselves tempted to insert the things into a system in which the objects figure as evidence of mastery and control, in which the objects and our arrangement and rearrangement of them take on a magical aura, the vestiges of a mad science (see figure 21).

  Fig. 21. Panels of fbdies containing case #1071 from the Chevalier Jackson Foreign Body Collection in the Mütter Museum. © Rosamond W. Purcell, 2009.

  The case of the four open safety pins entangled in wool and ensnared in the esophagus of a nine-month-old boy is linked by dint of extremity to another uniquely astonishing, incomparably difficult, harrowing, life-threatening, and miraculous case, one rife with dimensions of seemingly incomprehensible violence that go unmentioned in Jackson’s scrupulous documentation and discussion of it. While this case, too, features a nine-month-old boy and a collection of pins bound together, it distinguishes itself as a genre all its own: that of multiple fbdies all found inside the same body.

  On a spring day in 1923, James B. brought his son Joseph B. to Jefferson Hospital in Philadelphia following a series of horrifying and baffling discoveries made by his wife and their family doctor. Little by little by little, bits and pieces of the object world began to spill from the baby’s insides out. The discovery of odd objects—starting with buttons and unfolding into pins, cigarette butts, and burnt matches, starting with one object here, another there, and expanding into thirty-two objects (according to one account by Jackson), or thirty-seven objects (according to another account, also by Jackson), many objects, too many to altogether find or count—leaves us with a hollowed-out image of innocence confounded, because what must it have been like for Joseph’s mother to receive these perverse hints and not know what to make of them? To rock the baby, witness the baby’s discomfort, find and dismiss, find and pursue, to sleep and rise for several days without fully understanding what must have happened to her son, without her knowing that it did, that something indescribable, maybe even unimaginable, had happened to him, whose evidence she was receiving, if only she knew how to read it, if only he had words to tell it?

  Most of the case histories that remain from Chevalier Jackson’s foreign-body work are relatively short, one page, maybe two, but Joseph B.’s case spans several single-spaced pages and is accompanied by numerous X-rays, photographs, and displays (see figure 22). In away, the case of Joseph B. is its own archive.

  The baby starts by showing signs of a cough, and then vomits blood, which leads his mother to take him to the doctor. The possibility of a foreign body is ruled out when the mother informs the doctor that “the child was never permitted on the floor.” The mother later finds a button in the baby’s stool and imagines it to have fallen off his clothing. Several days later, the baby has a severe paroxysm of choking, leading the mother to attempt to clear his throat with her finger; she feels a “metallic object in the child’s throat which she removed and found to be a bent pin.” Soon thereafter, another bent pin, a needle, and three cigarette butts are vomited. A bowel movement reveals “two buttons, one bent hair pin, two safety pins (closed), two bent straight pins, and several burnt matches.” One wonders if the mother simply described the objects to the nurse taking dictation in the case, or if she brought them with her to the clinic. Whether she counted them as a way of maintaining her sanity, or if a clinic staff member counted them in front of her like so much change, perfunctorily, with astonishment or without, with clinical aplomb. Did the tallying help to normalize what must have felt beyond the bounds of reason?

  Fig. 22. A display of multiple foreign bodies removed from the body of an infant, case #1173, drawer 133, of the Chevalier Jackson Foreign Body Collection. Collection of the Mütter Museum, The College of Physicians of Philadelphia.

  Upon X-ray of the baby, the following data emerged: “Six foreign bodies in the gastro-intestinal tract, and an open safety pin in the pharynx with an accumulation of wire on the hinge of the pin, which is open and the point is turned toward the mouth. Patient then advised to see Dr. Jackson.” Subsequent descriptions of X-rays are more exacting:

  There are three safety pins in the pharynx, one fairly large, one small one and another so bent that is it [sic] impossible to tell the size, but it is probably the same size as the larger one above mentioned. This is about 1⅛ inches in length.... In the abdomen, there is a needle, a straight pin and a slightly bent pin without a head.... We are unable to say whether the pin is in the small intestines or the colon.

  Jackson uses this case, designated as #1173, to exemplify a diagnostic mode that can be aphoristically summed up as “never rule out multiple foreign bodies.” Had the staff in his clinic at Jefferson Hospital, preoccupied with the obvious ghastliness of the three pins wound together with a rubber band in the baby’s upper torso, failed to consider and therefore failed to notice the pin in the intestines, this baby would have died.

  Jackson’s extraction of the bunch of pins, is, as usual, incomparably deft: using a child-size laryngoscope and special rotation forceps, he rotates the mass of pins so that they can conform to one of his cardinal rules—that “the points trail when traction is made upward.” He removes them all, astonishingly, in under two minutes. The child is running a high fever at the time of the procedure and is later found to have been exposed to diphtheria bacilli, for which he is given an antitoxin; he undergoes upwards of twelve X-rays in the course of twelve days in order to monitor the remaining intestinal pin, and eventually, on June 18, 1923, undergoes laparotomic surgery under ether to remove the remaining, life-threatening fbdy located (the case study can now be certain) in the duodenum with the point perforating the intestinal wall. Having been admitted to the hospital on May 30, Joseph B. is discharged two months later, just under his first year of being in the world, on July 22, 1923, in “excellent condition.”

  Buried inside “the facts in the case” like a nearly throwaway line and never mentioned in any discussions of the case by Jackson, in spite of his multifold documentations of and returns to it for illustration, the following sentence appears in the case history under the heading Progress: “According to a statement made by both the father and the mother the child was cared for by a friend on May 28, and they believe that she deliberately fed these many articles to the child.” Notwithstanding the fact that the date of May 28 has got to be wrong (since the mother was reported as having noticed symptoms of her baby’s distress as early as May 26), the statement opens the case into a realm that we might not wish to enter. How can we reckon with the phenomenon of an adult forcing a child to ingest all manner of nonnutritive things?

  What could the perpetrator have been thinking? “Thinking? ” we might want to say. “She wasn’t thinking.” She was acting. She was hysterically miming some portion of her inner life cut off from her, now newly dramatized in the forcing of her fist down the throat of a baby. The baby’s mouth and throat showed no signs of trauma. She didn’t push, then, but placed, and yet she forced. She fed the baby with a mind to form rather than to content. When doctors act upon bodies in ways that are unimaginable from the point of view of laymen, we call it healing. What we usually miss in our expectation of a more feeling-full relationship from our doctor to us is that, though the doctor’s subject is something we both share—the body—he inhabits his body differently than we do our own bodies in order to carry out his work. Doctor and patient thus share a body (insofar as each of us is human) and live inside their bodies at a distance of radical departure. So, too, the force-feeder performs her task by way of an idea of the body that she doesn’t necessarily articulate but that is true for her and false to the rest
of us. The doctor, like us, is embodied, lives inside a body, lives and dies, but he knows his own body as well as ours in uncommon ways, the effect of which is to pretend it is not his body that he treats when he opens us, that it is not his body that is being touched when he touches us. Not his body. The person who filled a baby with things that his body could not withstand worked from the opposite direction: if the doctor too fully differentiates his body from that of his patient, the psychopathic feeder could not distinguish that baby’s body from her own. She acted upon a projection of herself—the baby’s body as a phantasm of some piece of herself, objectified and dis-embodied. She regressed to a primitive and unresolved form of play—the baby’s body as her plaything.

  Maybe she was testing the baby’s body or, then again, using the body of the defenseless child in the way people had used hers: the female body as depository, repository, or waste dump. Maybe her act was a literal stop-gap. We equate gagging with choking, but here gagging was equivalent to a form of forced swallowing possibly intended to stop the baby from making detestable sounds: the sound of his need, want, discomfort, or hunger. To feed the baby anything that was at hand was to gag the baby, to silence him. Forcing me to eat, you prevent me from talking; you stop my voice or my cry.

  Is there any realm so yoked to pleasure that also risks embarrassment, an outer limit, or shame as much as eating? Where a certain liqueur distilled from rose petals is concerned, not until it is swallowed does a secondary flavor burst through: the essence of roses. Some people don’t like to eat flowers, they reserve them instead for their scent, but the taste bud and aroma sensors are linked, so we might as well admit that to have a scent waft over us is to drink it, to smell is to imbibe, just as to hear is to reverberate unceasingly. Everyone probably has some memory of water forced into a nostril—a taste that instead of entering the stomach exits through the mouth, of sea salt or soap bubbles, chlorination or river shoal. Or how about a tuft or blade of grass purposely sucked on or accidentally mixed in with a picnic repast and the sudden stinging bitterness of indigestible earth-stuff, the ground we walk upon. Cavities in adulthood link voracity with childish abandon—those years of eating pixie sticks in lieu of lunch, of licking the stickiness of marshmallows from palms and fingers, of tearing cotton candy into edible cloud forms, of sucking the sweet center of a water ice long after eating it, by licking the ring of color it has left around your mouth. For shame!

  There are people who cover their mouths while eating and others who refuse to close them, quick chewers and slow, quiet and loud, happy and sad. Hunger is natural, but eating is learned. Or is it the other way around? Either I am taught how to want, or I am taught the proper way to get it. I can be taught ways of eating for the share of it—as if to say eating is a together act, so let me show you how to do it, the way that being taught how to crack the artichoke’s code is part of the pleasure of eating it. Certainly the way that we eat, ingestion’s form and formality or lack thereof, determines how we take food in and with what relish. Decorum, a way, can even make the inedible perfectly palatable—shoelaces spun with the proper attitude, twirled around a fork, just so, enable Charlie Chaplin to eat them, heartily, just as characters in Jan Svankmajer’s film Lunch eat the flowers and the table, and each and every particle of their clothes from their suspenders down to their underwear when their waiter fails to serve them. So long as our bodies convincingly perform the dance of eating—dipping a starchy sock into a shoe’s pretend well of gravy, looping a fork around those suspenders to approximate striped fettuccini, folding the underwear with a bread knife into the form of a compactly folded sandwich—we can ingest anything, these figures seem to say.

  Adults and children, children and children, adults and adults: the scale and pace and power is different in each relation of force-feeding. Children test their own and each other’s boundaries so much that inscribed in any one person’s childhood are episodes we might liken to scenes from Lord of the Flies: the girl was mildly retarded and younger than the others who formed the group. It was a hot day—that’s what made the earth so pliable—everyone was irritable, especially the parents, but the kids aspired to be “cool.” They were weak and spindly but wanted to be able to climb, so they pulled themselves up to sit in a row on top of a four-foot-high wall. Perhaps it was the fact of a spoon out of place—because there lay a teaspoon in the dirt, on the sidewalk, who knows why?—that inspired them to convince the girl who was younger and slow that dirt was edible, it even tasted good, that she should eat some. I was part of this scene, and I remember running from it, crying. Let me try again. I was a member of the “they,” and I stood on the sidelines watching. No. I was there, and I let the gaggle of these kids, “toughs” is what they were, rope me into confusing this girl even though I knew it was wrong. But if I dare myself to remember—truth or dare—that particular day, I’m afraid I was the ringleader of this team and I enjoyed it, that point at which the girl showed that she believed us by putting a spoon filled with dirt into her mouth.

  An undated and unmarked newspaper clipping in the archives of the National Library of Medicine describes the case of Mary Genova, nineteen years of age. Mary “wanted to borrow a sled. In order to get the sled the neighbor’s boy made her play marbles. When playing winter marbles he said you have to swallow them instead of shooting them. So Mary swallowed them, and here she is, in New York hospital.” An X-ray appears below the article; it makes Mary’s stomach appear to be filled with polka dots. Children forcing each other to swallow something in these two cases seem caught up in getting another person to believe something. These are games of lording it over someone, of manipulating trust, games of false conviction and betrayal.

  That force-feeding happens between adults has led to its gaining a name: “gavage,” they call it, but the French softening of the consonants does nothing to diminish the atrocity to which the word refers. Force-feeding seems to be a popular form of torture among humans—Serbs being made to eat paper and soap by Croats, Muslims being made to eat pork and drink alcohol by their captors at Guantánamo Bay. The hunger strike is a desperate form of defiance, mode of resistance, route to liberation, and it might work if it didn’t inspire the violent insertion of a tube into a nose, leaving one to wonder how a person so defiled ever comes to eat again, or breathe. How she ever dares again to swallow. When the modernist writer Djuna Barnes submitted herself to this in the form of a journalistic stunt, an act of feminist solidarity with the suffragettes who had endured it, I believe she must have regretted it, that she really didn’t know what she was getting into, how stripped she would feel of her body, how disoriented, how undone. If people force-feed each other in an attempt to subdue them, they no doubt oftentimes succeed.

  And what of Joseph B.? Where did this episode of forced ingestion, adult to child, leave him? Did he eventually develop a cancer that cut short his life as a result of all those X-rays? Did he sometimes feel beside himself and not know why? Did he live long enough to have children of his own, and did he feed them lovingly, like a bird feeds its chicks small bits of bread? How long did it take for the scar of a laparotomy performed in 1923 to fade? And what about the “family friend”? Whose child was she, and inside what kind of rooms did she live out her life to its close?

  An archive is a vestige and a vestibule, a place replete with remnants piled so high it sometimes blocks the view. Jackson exerted his designs upon this case as if to leave us with a tantalizing answer while erasing the question. He perpetually acts upon this case as if to right it, placing and re-placing its renegade pieces, on a tray or a plate, inside a frame, mixed together then unmixed again, so that we can, in a sense, consume them, take them in, and find them palatable. The items are striking, and the narrative attached to them is singular in the way that it enters into realms of atrocity, violence, in contemporary terms, of abuse and rape. But stowed as they are, positioned and recounted inside Jackson’s cabinet, they refuse, in a sense, to be grasped even when they are literally pinned down. T
hey recede and advance, recede and advance, asymptotically: never quite constituting the reality of the bodies from which they hail, nor quite crossing the Rubicon of dreams. Stowed in the cabinet, the fbdies that comprise case #1173, like all items in these drawers, are strangely equalized. They form a mass inside the cabinet-as-stomach, and even if we try to regard or re-regard each particular with wonder and let our imaginations work on it, we’re still drawn into a process of ingestion and digestion, a churning of our stomach-minds that transforms the collection into chyme (“chyme” being the word for what food becomes once the digestive system begins its work). Should the case of Joseph B. for a special category be reserved? Call it the fbdy case that cannot be taken in.

  Jackson’s photograph in Diseases of the Air and Food Passages of Foreign-Body Origin of the thirty-two objects retrieved is remarkable for the way the objects are painstakingly ordered therein (DAFP, 158). He not only identifies each object by name—distinguishing a “glove fastener” from a mere snap—but he numbers and alphabetizes each one, starting with A and ending with N, and in this way exhibits the things. “Ladies and Gentleman, I present you with Exhibit A,” he seems to say, and now the fbdies take on the character of evidence, but not as telltale items remaining at a crime scene or personal effects to be presented before a judge and jury in a court of law. In this form, this incarnation, the fbdies function as testimony and testament to nothing other than Jackson’s and his fellow operators’ skill. Jackson subtly separates out the items he extracted by positioning them in the upper left-hand corner, like a medieval letter in an illuminated manuscript. The things merely “passed” by the passive (if it can truly be called that) work of the patient’s body know themselves only in relation to the extracted safety pins as herald.