Mary Cappello

by Swallow: Foreign Bodies

  Imagine a woman naked but for her foreign bodies (see figure 29). At the head of the table on which the naked woman lies, distinguished only by her rings, pert nipples, and a fetching spit curl that mimics the curvature of a stomach, stands Chevalier Jackson. The head of the table would be the proper place for him, since he must stand behind her head in order to enter in. He wears a cape in lieu of a jacket, a paean to his effeteness (or to his love of France) and suited to his goatee. His right hand pulls on the fourth finger of his left hand the way a baby might suck on a thumb: the pose bespeaks some mild embarrassment over the long arrowhead of the bronchoscope that hangs in front of him and to one side. Here Jackson is part of an all-male lineup, a pantheon of faculty of Jefferson Medical College sketched by a Dr. C. Miksch in 1923 in imitation of Adrien Barrère’s “Nude Lady,” a caricature of a similarly posed Medical Faculty of Paris dating from 1906-7. Each man appears in caricature, his face collapsed beneath crinkled brows and sternly pursed lips. Not only are these men not naked; they are actually overdressed, each one provided with an accoutrement representing his medical specialty, the organ or body part as emblem of the branch of medicine to which he is devoted. Most wear a kind of blood-bespattered winding sheet atop their suits rather than a lab coat, the joke perhaps being that they may as well be butchers rather than doctors. The figure at the head of the table, DaCosta, wears a full apron into which is tucked an enormous pair of scissors and a butcher knife. He leans over the woman with the forefinger and thumb of both of his hands pinched together in the manner of a chef about to prepare the female patient for cooking rather than for operating. Or maybe just for seasoning prior to chopping. The strange presence of the woman’s jewelry on her otherwise stripped-down body makes her nakedness all the more apparent, obvious, and humorous.

  Fig. 29. A detail from the 1923 C. Miksch caricature of Jefferson Medical College faculty with Chevalier Jackson fourth from left. Courtesy of Thomas Jefferson University, Archives and Special Collections.

  At least two women endoscopists worked alongside Jackson in the course of his career: Ellen Patterson, his closest female colleague in Pittsburgh, and Emily van Loon, his closest female colleague in Philadelphia. It’s hard to imagine all that they had to negotiate in order even to inhabit the role of doctor or to carry out their work. This patently sexist centerfold—or, more to the point, panorama—is hardly an urtext in the history of medical misogyny, but it serves as an apt bookend or frame for the sorts of songs and ditties found in the annals of the Triological Society. It points up the extent to which practitioners of the healing arts came to confuse science with sexual mastery, intent on keeping others, and outsiders, in their respectively abject places.

  Something happens in the history of having a body and examining bodies that makes possible even as an idea the insertion of a rigid metal tube into the esophagus and later into the bronchial tubes. Something, too, happens in the history of having a body and examining bodies that makes possible as an idea the swallowing of huge amounts of hardware. Jackson daily put hardware into people’s gullets and called it an advance in medical science; wielding his rigid scopes, he was a pioneer on a bold new frontier. Women put hardware into gullets as well; it was considered a perversion entirely apart from Jackson’s practice, a psychopathology. We could say that what distinguishes Jackson’s act from that of hysterics was that he was sublimating—he obsessively inserted hardware, yes, but he did it in the name of a higher, greater good. Is the difference really that clear-cut, though? Are hysterics simply perverting something wholly reasonable, transforming it into an abomination, or is there more going on that we cannot easily account for?

  Which came first? The swallowing of hardware by depressed women, or the insertion of hardware into the human gullet as a new form of healing art? I believe that the advent of esophagoscopy and bronchoscopy made possible the swallowing of hardware, and that their coincidence is a result of a new way of thinking about the body: of apprehending the body as a machine. If the model of body-as-machine is traceable to the seventeenth century and Descartes, the body’s machinic incarnation was newly attenuated in the late nineteenth century; by then, as Carolyn Thomas de la Pena notes, “it was common for books on popular health to refer to hearts as ‘motors’ or ‘pumps’ and food as ‘fuel.’” Acknowledging, as we must, that various forms of instruments were introduced into the body’s orifices as early as Greco-Roman times doesn’t let us off the hook of discerning historical difference: the question that drives the need that forms the desire that incites the interest to enter in does not remain the same across millennia, or across cultures, and the endoscope as we know it is a product of modernity.

  Ralph Major’s wonderful essay on the history of the stomach tube documents ancient objects that range from feathers to long leather glove fingers stuffed with wool to, in the sixteenth century, hollow, perforated tubes made of lead, silver, or copper, but these were mainly evacuative and not examining devices. A Roman used a feather to relieve himself from overeating; a kind of artificial finger was used to purge, cleanse, or to expel a poison. Other types of early instruments were used to push a fbdy or caught food into the stomach, or, crudely, to catch hold of fishbones stuck in the throat, but most of Major’s examples are devices that served the purposes of cleansing or emptying the stomach of its contents. In a sense, these instruments were aiding a natural process or stimulating a reflex (to help a person to vomit), whereas the insertion of Jackson’s rigid tubes required that the body’s reflexes be subverted or subdued.

  We are in the realm of thresholds and of distinctions, because there is a difference, isn’t there, between one’s body being entered by a manufactured tool and one’s body being entered by the body of another—by tongue, penis, or hand, or by another person’s words, a voice inserted into an ear and down a throat. Is it personal predilection or acculturation that renders us docile in the face of invasive medical procedures—which is to say, most medical procedures in the Western world? What makes dentistry so unpleasant to most people is that it involves the insertion of instruments into the most delicate and vital and precarious of bodily orifices. Would we rest easier at the dentist if he were able to do his work using only his hands? I think I’d prefer flesh on flesh to metal probes inside my mouth, but maybe I’d most happily opt for neither. The speculum, that famously unseen instrument, is every woman’s nightmare. The “speculum” is in fact misnamed because it is not a mirror (as its etymology implies) but is, in a sense, like a bronchoscope, an instrument that makes possible a direct rather than a reflected view and that requires a secondary light source. Doctors were initially more willing to put instruments into the orifices down below than those above, and some of the first esophagoscopes were based on scopes for examining the urethra and bladder. Again, what would you prefer? For your gynecologist to open you with her hands or with her instrument? Or maybe not to open you at all?

  Products of the industrial age, Jackson’s tools have examination, visual exploration, manipulation, and mastery in mind. They are first and foremost scopes—and ones that fulfill an interest in peering into the living body. The long view of endoscopy as a practice shows it to be a product of the Enlightenment, and the history of endoscopic instruments to be inextricable from the history of light. Endoscopy as an idea is literally driven by a desire to bring light into darkness—to see one’s way in the dark—and to test the limits of the human perceptual apparatus to, if properly applied, see further, clearer, more fully and entirely into realms otherwise reserved for a higher power.

  Phillip Bozzini, who between 1803 and 1808 developed what is considered the first true endoscope, virtually defined the instrument as a vehicle of light in the very name that he gave to it—he called what he had designed the Lichtleiter, or “light conductor.” Medical historian James Edmonson’s indispensable article “History of the Instruments for Gastrointestinal Endoscopy” describes the trial and error that accompanied various lighting systems in endoscopy’s history: candles
reflected in mirrors, oil lamps and alcohol-turpentine mixtures, the burning of magnesium wires and loops of platinum charged with an electrical current that proved so hot that a cooling system was also required. Each of these methods deterred potential endoscopists and discouraged endoscopic development until 1879, when Edison’s incandescent electric light offered an unsurpassed possibility for peering inside. The substitution of platinum wire with a tiny incandescent bulb in 1886 rendered an instrument designed by Johann von Mikulicz “the first truly usable esophagoscope,” according to Edmonson. In Jackson’s scopes, the distal lamp (or light carrier, as it was also called) consisted of a handmade battery-charged lamps the size of a grain of wheat mounted at the end of an exceedingly thin rod that was slipped inside the scope. Sleekly penetrating and perfectly luminous, it’s no wonder that Jackson named one of his scopes “the velvet eye” (B&E, 27; see figure 30).

  When Jackson accesses the body via one of his famous bronchoscopes, he is moved not only by the visual display the device affords but by the part the instrument allows him to play in a grand machinic process.

  Fig. 30. An array of scopes from Jackson’s vast instrumentarium with accompanying distal lights. Collection of the Mütter Museum, The College of Physicians of Philadelphia.

  The particular problem that Jackson faces is a body imagined as a machine that is not equipped to process the foreign object that has fallen into it. Jackson, in turn, makes the body—via deft positioning of head, neck, and throat, the acts of assistants upon the body, and an inventive set of instruments that he introduces into the body—into another kind of machine, one from which the foreign object can be extracted nonsurgically.

  Although Jackson removed foreign bodies through the mouth without surgery and engineered forms of entering the body without cutting into it, his procedures are not really “operations” in the strict sense of the word, yet he called the room in which the ingested items were removed the operating room, and the doctor who performed the removal was not the surgeon but the “operator.” What exactly is the doctor operating if not operating on something? Is he operating the instruments or the body-as-machine into which they have been inserted, or both?

  Here’s an illustrative tale: to demonstrate the need for legislation to protect children against the ingestion of lye, Jackson photographed himself next to a particular type of machine—a wooden-cogged mortise wheel and iron pinion known as a “man-eater.” What was the logic here? Jackson explained that “arms, heads, or anything that got caught in the inmeshing side of the gears [of this machine] went through,” thus eventuating the requirement that this “dangerous machinery” be guarded by screens and covers. Jackson used the machine to emphasize, by contrast, the lack of legislation to protect children from the dangers of lye. The connection is made by inverse analogy: the mortise wheel, an inorganic thing, has the ability to “eat” a person; and a person has the ability to “eat” an inorganic thing. In both cases, something has gotten into the machine (mortise wheel or body) that wasn’t meant for it, necessitating prophylactic measures, protective screens that, in the case of real machines, might work, but in the case of human bodies, much to Jackson’s frustration, almost always failed.

  Here’s Chevalier Jackson as foreman, hoping to monitor ingestion like clockwork. There he is intervening at the scene of a body’s irregular inspiration hoping to restore the smooth functioning of interrupted cogs.

  By inserting rigid tubes into people’s gullets in order to examine their insides, he was reinventing the body as a kind of machine, but its protective reflexes had to be disabled in order for his tools to enter in. He was a master of getting people and their bodies to cooperate without being cut. The very image his patients had to have of their bodies in order to allow Chevalier Jackson his work is the same image that a woman capable of swallowing hardware had to have of hers: a body that could expand and withstand (in medical terms, a body that could “tolerate”) all manner of parts. Were hysterical hardware swallowers simply rehearsing what medicine in the machine age was heralding and propounding as inevitable? Readying themselves for the next machinic insertion, and the next.

  Therefore I do not much wonder that the Ostridge can eat and digest iron.... Leo Africanus saith, that they swallow whatsoever they finde, even iron.... As for Pliny, he saith plainly, that it concocteth whatsoever it eateth. Now the Doctor acknowledgeth it eats iron: Ergo, according to Pliny, it concocts Iron.

  —ALEXANDER ROSS, Arcana Microcosmi (1652), book 2, chapter 8

  For more than 2,000 years the sword swallower had solved the problem of

  the stretching of the mouth-pharynx angle. This teaches us modesty! . . .

  Notwithstanding the fact that they have rendered good services to the

  development of esophagoscopy, there is hardly any literature on sword

  swallowers. Now . . . there is certainly a reason to give credit to them

  because this interesting guild will probably soon be extinct.... We have

  come a long way from Kussmaul to Jackson.

  —EELCO HUIZINGA, “On Esophagoscopy and Swordswallowing”

  The taboo which has been violated is, perhaps, one of the oldest known to human beings—that the interior recesses of the body are not merely private to others, but peculiarly private—that is expressly forbidden—to the owner or inhabiter of the body.

  —JONATHAN SAWDAY, The Body Emblazoned

  That some people have taken to swallowing Velcro at first seems hard to believe until you think about the deeply satisfying press-and-rip aspect of that substance, the way it mimics eating with its tiny teeth, or enmeshing, or textured attaching and holding in place. Perhaps those who swallow Velcro are convinced the act might lend them some of its clearly magical properties. Velcro probably feels good on the way down in that indescribable way, like a backscratcher meeting the itch of an otherwise unreachable spot. Researchers of pica don’t appear to be kidding when they designate people who like to ingest blood “Draculas,” rather than invent a more official-sounding -phagia for them. Velcro and blood seem far afield, yet both are specific enough to make us realize how acts of swallowing leave new forms of identity in their wake: is a Velcron like a Klingon or someone less strange, as neighborly as the man next door? And when was the last time you admitted to or checked your own vampiric tendencies?

  One type of human swallow can be likened to a disappearing act, as in the case of a vaudevillian who ate glass, matchbooks and lit matches, flowers (stems and all), and an entire newspaper without a hint of where it all went. (Did he really swallow that stuff or just pretend to?) Another type entails repeatedly swallowing a pellet tied to a string. Over a number of years and with recourse to increasingly larger pellets, a person can enjoy a throat pouch suitable for smuggling things, and thus the possible exploitation of the body as a truly secretive place.

  Swallowing acts. Swallowing tricks. Swallowing as a form of defiance. Swallowing as a test case for the limits of sense and nonsense, as in the example of “H.F., male, aged twenty-three years,” who, according to the 1922 New York Medical Journal and Medical Record, was “showing a little boy the trick of inserting a penny into his nose and withdrawing it from the mouth. He thrust it too far back and it became impacted in the upper esophagus.” E.L., a seven-year-old contemporary of H.F., exerted an impish, stubborn use of the mouth when, “in the course of an argument as to who should carry the money,” herself or her sister, as they walked to the store, she “swallowed a twenty-five cent piece. She was seen five days after the quarter went down.”

  Should I believe myself or believe the instrument that examines me and, which, in entering me, reads me? Does it tell me my truth? Does it see me fully and conclusively? Apparently “hysterical,” “S.S., female aged thirty-nine years presented with the inability to swallow anything and the conviction of a tumor” that “she localized below the clavicle.” Esophagoscopy presumably cured her by passing the tube under local anesthesia into her throat. At the aperture that is
the mouth, we therefore see enacted a battle over belief. Teetering on a threshold of the real, she is convinced by the instrument that something is open rather than closed, available to light rather than dark, passable rather than impassable, fluent rather than blocked. But does it clear everything up? Is the application of medicine’s instrumentarium entirely demystifying?

  There are spectacular swallows and celebrity swallows, and spectacular swallows that make people overnight celebrities, but what kind of star is born of an unusual ability to swallow? Chevalier Jackson saw Bing Crosby once or twice as a patient, treating the overworked singer’s throat. You can discover this in Crosby’s biography but not in any of Jackson’s work. Notoriety of this sort did not interest Jackson in the least. Other celebrities’ swallowing accidents postdated the life of Chevalier Jackson. Places are reserved in the popular imagination for Elizabeth Taylor’s chicken bone, Jimi Hendrix’s vomit, and Mama Cass’s (apocryphal) ham sandwich. In Cass’s case, the coroner, confusing Cass with a kind of circus Fat Lady, concluded that she died of self-engorgement when in fact the ham sandwich she was supposed to have inhaled sat by her bed, untouched. Cass died of heart failure, possibly brought on not from overeating but by the numerous crash diets she was compelled to pursue.

  There’s Ronald Reagan’s peanut kernel, George W. Bush’s pretzel stick, Carrie Fisher’s brussels sprout, and Cher’s vitamin pill—these all appear together in a 2006 Talk of the Town story in the New Yorker about the independent film Choking Man. The article centers on a bizarre coincidence: Mandy Patinkin, star of the film, finds himself choking on a piece of Caesar salad and is saved by the Heimlich maneuver, fast on the heels of doing a good deal of research on various “asphyxiation scenarios” in preparing for his role.