Mary Cappello

by Swallow: Foreign Bodies

  No sooner had I felt the astonishment of finding Jackson’s own illustrations of Margaret’s case than I realized something that felt terribly sad—I remembered what Margaret remembered so well, that Jackson had not treated her, and if he hadn’t treated her, he could not have illustrated her case. He only illustrated what he was present to have seen—those views through his scopes. The pin in drawer 70, case #565, I hated to admit, probably couldn’t have been Margaret’s. That would explain why she did not remember hemorrhaging. Because she hadn’t hemorrhaged, and hemorrhaging, according to the illustration, was the major feature of this case.

  Margaret Derryberry was right: she had always been keen to stress to me that what she had inhaled was a hatpin, while case #565 described a shawl pin. And Chevalier Jackson was never wrong. It hadn’t been a shawl pin; it had been a hatpin, so this wasn’t her pin. Margaret knew quite well what she inhaled, but the collection failed to confirm her knowledge. It cannot do that for a person. Try as we might, it is quite unlikely that we will find ourselves in this cabinet, safe, secure. Margaret’s hatpin is irrecoverable.

  Fig. 33. Illustrations in oils of bronchoscopic, esophagoscopic, and gastroscopic views. Case #565 (what had been thought to be the case of Margaret Derryberry) is represented by figures 5 and 10 (DAFP, 124).

  We seek to find ourselves, to be individuated by and through an object, especially if that object was at one time inside us or a threat to our lives. But the objects inside the fbdy collection blur into one another as they coalesce into a singular subject: their author. Once again, a living former patient’s reclamation of experience inside the clinic hinged more on the absence or presence of Chevalier Jackson than on the absence or presence of the object or of the patient. You can’t blame the educational director, because it is hard to believe that more than one—in fact, a multitude—of eight-year-olds might have come to Jackson’s clinics with hatpins in their lungs. What are the chances of finding one’s own pin inside a sea of pins?

  People, myself included, wish to make the fbdy collection less anonymous. One of the greatest aftereffects of the fbdy collection may in fact be the twists and turns, the truly labyrinthine routes, that people with a connection to the collection might take to find themselves therein even if arrival is futile. The spring 2009 issue of the newsletter of the American Broncho-Esophagological Association (ABEA), the organization that Jackson founded, shows this individuating impulse at work. The presidential guest of honor at the organization’s proceedings is a Mr. Pepa, who is distinguished by the claim that he is Chevalier Jackson’s “oldest living patient,” who “will speak briefly about his experience being a patient of Dr. Jackson and present photos from his time in the tracheotomy ward.” Also featured in the newsletter is a story recounted by Dr. Wayne Hellman about his grandfather Rudolph Hellman, whom Jackson had rescued from a potentially fatal brass cap in 1916 when Hellman was a boy. Dr. Hellman quotes a note written in 1999 from the Mütter Museum’s late curator Gretchen Worden: “I have never met anyone or heard of anyone with a personal interest in our Jackson collection.” Including this note seems to suggest that he is the only living person to have a personal relationship to the collection, itself an example of someone’s desire to individualize the otherwise indiscriminate mass of Things. The impossibility of using the collection this way, however, is strangely a consequence of Jackson’s own doing. His hope for the collection was to create what he called “canned experience” for future practitioners. Did this mean that only his experience was original, and everyone after him was to be a copycat? “A parallel can be found for almost any case encountered,” he explained in Diseases of the Air and Food Passages of Foreign-Body Origin. In other words, what the collection offers the practitioner is a duplicate, a double of the case before him so he can work by example. There are no unique yous to be found inside examples; the power to duplicate exacts an erasure of the individual and of the individuating.

  The pin inside the frame of case #565 is Margaret Derryberry’s in this sense: she found it. And lavished attention on it. And it found her. And I found her, through it, she found me: the object was lost but the story was found. Whatever happened to the original pin, we’ll never know. Was it carried across the lane in a beaker, carried away on the wind, a sad sliver lost to the crack in a sidewalk? What remains is an intimacy forged across the drawer of one of Jackson’s objects in his cabinet of curiosity. Because Margaret and I shared a fascination, which doesn’t mean together we form a coterie.

  Margaret led me to learn something of the history of hatpins and their relationship to the history of women. The period between the 1880s and the 1920s marked their heyday, a period during which women were liberated from their ribbon-tied bonnets and freed to display a range of hats better suited to new and daring hairstyles. So linked with women’s power were they that, in the early twentieth century, various laws were passed limiting the length that a woman’s hatpin could be. According to the American Hatpin Society’s Web site, the pins were considered deadly weapons. The phrase “pin money” has curiously complicated origins around consumption and production (and desire). It may refer to an early-nineteenth-century edict in England that restricted the sale of hat and other dress pins from France to two days out of the year, January 1 and 2. Women, saving their money in anticipation of those days, were accumulating “pin money.” Or it may refer to Queen Victoria’s taxing her subjects at the beginning of each year in order to pay for her own fancy pins.

  See that hatpin with adjustable ends for swiveling its glittering stone, or this elaborate model with a screw-on container for holding smelling salts, a tiny mirror, or a powder puff. The pin that Margaret and her friend were playing with was simple, she had told me, not ornate, but even a simple hatpin is equal to a complex material culture and a replete personal history—a history, in fact, of the body. Of course there is power in the evidentiary, but an object—and here’s the twist—may not be reducible to its material trace. Margaret Derryberry’s pin materialized in our conversations. Together we found it, and made from it affection, and now I stow it in this chapter drawer.

  It’s hard to acknowledge that, at the beginning of our relationship with one another, Margaret was coming to the end of her life, and that she knew it. Margaret knew what no one wished to. She’d asked if I’d been able to find any other still-living patients of Chevalier Jackson and then added, “You’re going to think this is terrible, Mary, but when you suggested times for calling, I thought to myself, ‘Better do it now, you might not be here Thursday!’”

  According to our ongoing e-mail correspondence, there had been no spring either in Providence, Rhode Island, or Frankfort, Kentucky, in May 2007. I complained that the new shoots in my garden were met with the stifling air of late summer rather than the temperate breezes of spring; she reported that where she lived it had gotten very warm, and “new growth appeared and then we had a hard frost. Consequently, things got nipped. I now have a green and yellow hedge out front . . . which I can’t trim because cardinals are raising a second family in it.”

  We know a child body can sob, but can it gasp, or is that something only adult bodies do? Margaret Derryberry led me to Alexander Pope, and left me with Gerard Manley Hopkins. To a poem filled with oddly tilting lilts and backward-turning breaks, with heightened silences and mysterious measures. Now I find, and lose, and find again that verse called “Spring and Fall”; it is Mar-ga-ret I mourn for, with an emphasis on each hale syllable of her name.

  Instrumentality and Instruments as Things

  It seems necessary from the outset to state that this presentation is from the author’s individual viewpoint, which means that of one who metaphorically, as well as actually, sees narrowly through a small tube.

  —CHEVALIER JACKSON, “Discussion on Overlooked Cases of Foreign Body in the Air and Food Passages” (1925)

  Lightness of touch was one of his hobbies.

  —Chevalier Jackson’s handwritten notes for his autobiography, Smithsoni
an Institute

  I must move on now before age overtakes me and makes my hand tremble. (LCJ, 209)

  In spite of Chevalier Jackson’s hopeful and instructive legacy, peanuts, coins, and safety pins still top the charts of most frequently identified foreign bodies, Christmas tree ornaments continue to appear (no other holiday detritus seems to enter people’s bodies so unceasingly), and so do jacks, yet fbdy cases are still treated by some physicians as anomalous firsts. Consider the man who recently inhaled a “fast-food foreign object.” Though fast food hadn’t been invented in Chevalier Jackson’s day, plenty of plastic had already been inhaled, yet this recent case of a North Carolina man beset by fits of coughing and undiagnosed respiratory distress was met with bafflement and surprise. Doctors eventually determined that the patient’s lung was harboring a foreign body, but according to newspaper reports, “they couldn’t figure out what it was or the best way to retrieve it.” One doctor suggested that the easiest strategy would be to remove the man’s lung entirely! Fortunately, the case came to the attention of a pulmonologist at Duke who, more regularly engaged in removing cancerous tumors from people’s airways, suggested he could attempt to remove the fbdy using a rigid bronchoscope—that is, the “à la Jackson way.” Waiting to see what might be lurking inside the man’s lung, the operating team was amazed when a plastic fragment of a Wendy’s eating utensil came to light. “We’re as quizzed by the whole situation as everyone is,” the doctor reported. “This is quite a surprise that this could even happen.”

  The patient’s admitted tendency to gulp down his Wendy’s (fast) food aside, what intrigued the operators even more was that the fbdy bore a message. Realizing that the fbdy had letters on it, the operating staff began to read aloud: “A-M-B-U-R-G-E-R.” The idea of carrying around an object that bears part of the Wendy’s motto—“Old Fashioned Hamburgers”—is more tantalizing than a bit of actual stuck hamburger would be. Foreign bodies that need to be read command a special place in fbdy lore, as though things caught in bodies are more fascinating if they bear a secret-seeming message, issued from who knows where. Message-bearing fbdies take on special meaning, like things first hidden and later found, like messages in bottles with their singular allure.

  The beauty of the seaborne bottle is that it can bob perpetually and traverse vast distances without the aid of any transport system except the currents of the sea; the riddle of it is how long it will take to be found—if it ever will be found—and where in the world it will next show up. A pin enters a knee and comes out through the chest; another begins inside the gullet and emerges from behind the ear; a third goes in at the mouth and exits through a calf. (The three examples taken together offered more than enough fodder for a 1937 article in Popular Science, “Strange Things That Roam Through the Body.”) A bottled message is dropped off the coast of Brazil and arrives on a beach in Africa, enters the Southern Indian Ocean to arrive at the west coast of Australia, is deposited in Rhode Island’s Narragansett Bay and washes up in southwest England, or begins in the Baltic Sea and resurfaces in San Francisco. We’re intrigued by these strange meanderings, and it’s not always clear if we want to solve, or to predict, the body’s currents or the sea’s, or if we’re simply happier not to know: to entertain the latitudes of wayward sojourns that we, ourselves, are loath to take. Wherever it arrives, the message in a bottle culminates with its recipient. Do you smash the bottle or fish the message out? If the bottle is plastic, do you cut the bottle open or try to preserve the vessel intact? Is the message, once read, bound to have a lesser yield than the fact of the bottle itself, as though to read it and receive it is to break its spell?

  Think of all the precious objects washed up on the shores of yard sales! A mirrored cabinet; a leaf-pressed bowl; a three-legged stool with the face of a gargoyle. On one occasion, a small wooden box marked “50 cents” with a scene inlaid on its lid. For fifty cents, it might make sense that the box, when you carried it, threw up a rattling sound as though a broken-off piece were stuck inside it. But for fifty cents, you wouldn’t imagine that the sound was made by an object, not broken off but secreted inside. How to access the thing, that is the question, and the minute you ask this, you discover that the box has camouflaged movable parts—it’s not just any box, but a Japanese puzzle box. The pleasure in cracking the box’s code is unspeakable. The primitive back and forth, give and take, here and gone, of being oneself puzzled, and solving the puzzle in turn. The detail of one part of the box requiring the shifting of a moveable miniature book, like the feeling of finding a life-size library’s hidden door, and then the revelation of the Thing inside: a tiny, eminently swallowable key.

  How a person goes at the box is revelatory too, and Jackson’s methodology is the best example of this. Can you tackle the thing without breaking it? Do you favor your eyes or your touch in the process? Do you palpate or knock? Do you examine or notice or do you just bite into it? Do you pry? Do you spin the box on an axis, hoping for a lucky pointer in a game of chance, or visualize its openings and calculate its angles, preserving its integrity, in turn? Each of our methods of resolution tells us something about ourselves, our temperaments, our interest in and our patience with an object, our aptitude for curiosity.

  From John Kirkup’s The Evolution of Surgical Instruments, we learn that the production of the earliest surgical tools was driven by the need to remove foreign bodies—splinters, thorns, and bodily intruders that needed plucking out—and that the human hand and the human mouth, which were used to suck out or otherwise remove foreign bodies, served as these instruments’ prototypes. Devising special tools to extract bodily invaders is as old as humankind, but this doesn’t mean that such instruments were applied with elegance or aplomb. In fact, the results of inserting instruments into the mouth, throat, stomach, or lungs were pretty uniformly dismal before Chevalier Jackson introduced his unique array of scopes and forceps, his adept and thorough instruction, and his incomparable technique.

  In his illustrations for one of countless sets of “endoscopic views illustrating mechanical problems encountered in cases of foreign bodies in the lungs,” Jackson remains dumbfounded by the fact that his “predecessor in the case stated that he had grasped the foreign body and had pulled as hard as he dared” (NMP, 91). In a record of remarks from a 1921 article on new mechanical problems in bronchoscopy, a Dr. William B. Chamberlin of Cleveland, Ohio, uses a metaphor that likens doctors to overeager, testosteroned killers, whose “haste and zeal to seize a foreign body was similar to what hunters called ‘buck fever,’ they were so anxious to shoot that they missed.” Dr. Louis Clerf, in his 1952 address “Historical Aspects of Foreign Bodies in the Air and Food Passages,” revisits some of the cruder forms of removal and the transition from outmoded methods toward supposed technical improvements in the mid-nineteenth century:

  Until [Samuel] Gross presented his views on the subject it was of common occurrence to use some form of bougie to push the offender downward into the stomach. In fact in one of the very early cases reported from India, a certain gentleman used his cane to aid the progress of a mass of meat on its way to the stomach. Gross advocated the use of curved forceps, blunt metallic hooks, a piece of wire formed in a noose or with a piece of whale bone or a gum elastic catheter furnished with a stylet or having a piece of sponge, or linen ball or something similar attached to its lower extremity. A number of ingenious instruments were devised, notably the Gross probang and the Graefe coin catcher.

  I’m not sure why Clerf describes these instruments as ingenious, since they seem mainly to have been ingeniously fatal. “Mishaps,” followed by the patient “succumbing,” seem to have been the order of these instruments’ day. Jackson’s predecessors as well as his contemporaries were responsible for blind graspings and jabbings until the fbdy was lost; they attempted to remove tacks without first disengaging the point; they “morcellated” peanut kernels, thus leaving the patient with a scattering of peanut bits trapped in the airway, which led to fatal abscessing; th
ey suffocated patients by compressing the trachea with instruments whose bulk, together with the size of the fbdy, were too great or that, in combination with general anaesthesia, suppressed the patient’s ability to breathe; they overshot the fbdy with their scopes, relying on what Jackson called “injudicious traction”; they dragged the foreign body forward and took human tissue with it; they pulled, they tore, they lacerated. The history of endoscopy is riddled with practitioners heading out into the terra incognita of the throat, the stomach, or the airway, stalling petrified before the entryway, entering in successfully, but then inciting an “accident” on subsequent attempts and closing up shop altogether, abandoning further development of the instrumentarium.

  It’s an early winter day in Brooklyn; no doubt everyone else’s hands are chafed except for dainty, cared-for Jackson’s when he delivers his lecture and lantern demonstration to the Kings County Medical Society on December 19, 1911. “It is one of the sad duties of the oesophagoscopist to see little children brought in dying or seriously ill from rough, unjustifiable, brutal attempts to remove a foreign body by such relics of obsolete surgery as the Graefe basket, the coin catcher, Bond’s forceps, bristle probangs, etc.,” Jackson opines, but then backtracks slightly as if to rescue the work of his peers, at least partially: “It may be thought that the bristle probang should not be included here. Possibly its use may not be very dangerous in the adult, but in infants it is, to my certain knowledge, often fatal. The only safe method is to proceed only under the guidance of the eye, as in modern oesophagoscopy.”