Mary Cappello

by Swallow: Foreign Bodies

  “Examination is difficult because of pain complained of by the patient when chest is percussed,” Clerf notes on his initial observations of the boy, and his is just one of several meticulous accountings of the examination of the boy’s body. Manges describes the attempt by numerous X-rays to create a detailed map of the location of the coin, and after gaining permission to have the boy swallow some bismuth so as to yield a clearer picture, Manges is able to conclude that the coin had indeed “eroded through the esophageal wall, the pleura and into the left main bronchus.” An autopsy report reveals an “American half-dollar embedded in the coronal plane of the esophagus”; it determines that the heart weighs 110 grams, and measures 8 × 6.5 × 3.5 cm; describes “the little fellow’s body[as] pale and wasted”; and adds to the list of death’s causes “gangrene of the lung.”

  Fig. 46. Michael H., who died as a result of an ingested American half-dollar that numerous doctors failed to believe in and that therefore went untreated from the time that Michael was four until the time of his death, at age ten. Foreign Body in Air and Food Passages: Roentgeneologically Considered, with Two Hundred and Thirty-six Roentgen-Ray Studies and Ten Clinical Illustrations (1934).

  Extensive descriptions of the particulars of the damage done by the coin to the boy’s body in an age before antibiotics can’t really help the boy and seem like failed efforts to fill the gaping holes left by misinterpretation and disbelief. The story of Michael’s life after he swallowed the coin—from the time he was four-and-a-half years old to the time he arrived in the Jackson clinics at age ten—is one of repeated attempts by himself and his father to convince numerous doctors of the presence of a fbdy in his throat. A Polish doctor in New Britain, Connecticut, where the family lived, had been consulted immediately after Michael swallowed the coin. X-rays failed to reveal the coin, and the doctor “told father that he did not believe child swallowed the coin; if he did, it would cause no harm.” Soon thereafter, they visited another doctor, named Zwick, whose further X-rays also did not confirm the boy’s admission of a swallowed coin. Afterward, “this child was seen by a number of physicians, all of whom laughed at the father for believing the presence of the coin was the cause of his child’s illness.” The child had difficulty swallowing solid food, his growth was stunted, and he suffered from a constant cough, often accompanied by regurgitation and vomiting. At ten years old, the boy was diagnosed with consumption by yet another doctor. The doctor told the father that the “coin was not present and not the cause of the trouble.”

  Failure is the keynote of this narrative, and finally a schoolteacher sent a truant officer to the boy’s home “because of the child’s failure to attend school.” The officer, finding Michael to be quite ill, took him to a hospital in New Britain where “fluoroscopic examination shows the coin to be present, in the mid-line of thorax, about 3 inches above diaphragm. It was believed to be in the lung having ulcerated through into the lung.” Just as father and son returned to Dr. Zwick with the new diagnosis, more than five years overdue, Michael developed what his father called a boil over his left lower chest; the doctor attributed it to “poison in the child’s system due to the presence of the coin.” Zwick performed an operation of some sort to relieve the boil and wanted to “remove the coin” at the same time, but the father would not permit it, and “Dr. Zwick gave up the case.” Then the father visited another doctor who, upon seeing the X-ray, advised him to bring the child to Jefferson Hospital.

  I don’t know if Michael had much of a childhood—if, on some clear days, he played with a puzzle or dangled a piece of yarn in front of his cat; if he caught things in nets or read storybooks; if he waited by a window for the snow to fall, or rolled down small hills the way apples languidly drop then roll out from beneath the shade of their trees. The fifty-cent piece was always there, throbbing, blocking, inarticulable to a child, yet truly felt. The problem with the fbdy was that it stayed lodged, but the body was still growing, and its growth could not accommodate it. Here’s what we don’t know: the circumstances by which Michael swallowed the coin. Here’s what we do know: his and his father’s command of English must have been impeccable for their story to have been recorded. Here’s what the case study shows: Michael had been in life, and in death, carefully examined, but he had never been understood.

  How did Michael swallow the coin that eventually made him so ill beyond imagining? Was it the effect of an “expression of emotion,” or was it attributable to the “properties of the foreign body itself”? Was he not properly watched over because of being poor? The sundry visits to numerous doctors imply that his family did not live in poverty. Had he been “taking a deep breath to cough or sneeze,” or had he been in the habit of imitating conjuring tricks with coins? Was he surprised by how large the coin was—about the diameter of a dollop of ice cream—and did he wish to determine if he could fit his mouth around it? Was his swallowing the half dollar an untoward afterward of “recumbency,” “running or jumping,” or “sobbing, laughing or whistling”? Certainly he wasn’t drunk.

  In the caption underneath the patient’s picture in his Autobiography, Jackson is so frustrated by the case that he becomes nearly heartless, returning quite predictably to “carelessness”:

  A boy nearly dead and emaciated almost to a skeleton from abscesses in his lung due to prolonged sojourn of a coin he had swallowed. Had he been taken to any hospital promptly, the abscesses could have been prevented by esophagoscopic removal of the coin. Better still, such an accident could have been avoided if the coin had not been put in the mouth.

  What Jackson subtracts is the fact that Michael’s father had taken him to a doctor “immediately,” and that an “X-ray examination was made at a hospital in New Britain which failed to reveal the coin.” Michael’s case was a very special one to Chevalier Jackson in this way: it was a case that Jackson could not solve, before which he was left to feel helpless. No attempt was made to remove the coin at Jefferson Hospital because, I surmise, by the time the coin had been believed in, and therefore looked for and finally discovered, the boy was already too seriously ill and the coin had done too much damage for any endoscopic procedure to be safely carried out.

  In yet another caption attached to Michael’s photo, in the earlier Diseases of the Air and Food Passages of Foreign-Body Origin, Jackson used the case to prove a more relevant cardinal rule of his, namely that the

  chief etiologic factor in all the pulmonary pathology present in this boy was the over-looking of the foreign body. Had an early diagnosis been made there would have been no pathology; the foreign body could have been removed by esophagoscopy and there would have been prompt recovery, or, rather, as in the patient shown in Fig. 5, there would have been no illness from which to recover.

  Had Jackson lost the documents in his attic by the time he wrote the Autobiography , when he used the photo to tell an entirely different, finger-wagging tale? It’s as though Jackson suffers from selective amnesia. Had he detached the photo from the case notes and, with nothing but the appalling figure of the boy to contemplate (a human being reduced to a pile of bones), felt overcome by the feeling that the horror it depicted was not his fault? In Diseases of the Air and Food Passages of Foreign-Body Origin, he used Michael to exemplify part of the gospel he had preached throughout his life: foreign bodies must not be thought of as curiosities but must reside in the realm of the possible, the ordinary, the likely, and the real. Convincing fellow doctors of fbdies as commonplace was part of Chevalier Jackson’s crusade, but his tendency to save, his need to keep, his collection rarified them yet again. The Chevalier Jackson Foreign Body Collection does not necessarily encourage fellow doctors to look for foreign bodies, believe in them as likely, and expect them at the door of each new cough. Instead it leaves them, mouths agape, in awe of a master; it permits a certain lolling and retreat; it festoons the imagination and dots the crenellations of a dream.

  Is the Chevalier Jackson dreamspace his self-reward for an allegiance to precision? Arl
ene Maloney reminds me that endoscopy with rigid instruments is an exacting science—a hairbreadth off with the position, direction, or pulsion of the instrument and you could ruin a person’s larynx or inflict a fatal injury. Chevalier Jackson never searches for a fbdy without a map of the body that he already knows like the back of his own ambidextrous hands. With newfangled search engines at my disposal in the year 2009, I expect my journey to find Chevalier Jackson to be easy. I’ve set a Google alert for him so that, whenever a new piece of knowledge attaching to his name appears, I’ll find it. Rarely does anything turn up, though occasionally the inexacting, lumbering World Wide Web alerts me to an article on Michael Jackson.

  One of these times, unwilling to feel lonely or betrayed by my research, I click on a link to the more famous figure with that surname. It pulls up a video of Jackson in a live performance of “I’ll Be There,” which has resurfaced after Jackson’s untimely death. Rising toward the performance’s final fever pitch, Jackson throws his head back, far back, as though he’s preparing to swallow a sword, if only an imaginary one. Really, he’s preparing the back of his throat to produce a sound more exquisite than silver, more porous and more fluent than steel. He holds his hands atop his mouth to hold the note, cupping them around an invisible rope or bar of something going into him and something going out of him.

  On another occasion, across several years of life with Chevalier Jackson in which his name appears in my alerts, I’m directed to the place where his bones are interred. I’ve never thought to make a pilgrimage to Jackson’s grave—is this because it would mean my work was over?—but here I can visit his “resting place” by way of a virtual tour. Laurel Hill and its sister cemetery, West Laurel Hill, where Chevalier Jackson is buried, “is more than just a cemetery,” the Web site for these burial grounds assures. “It is an outdoor sculptural garden, a horticultural gem, and a truly unique historical resource. It also happens to be one of the few cemeteries in the United States to be honored with the designation of National Historic Landmark.” As a burial ground unrivaled in its “peace, beauty, and splendor” since its founding by Quaker Joseph Jay Smith in 1836, it can’t even be considered the rich relative of once plunderable (and later condemned) Lebanon Cemetery. It seems, instead, to exist in a world apart, its citizens’ bodies invested with great value worthy of undisturbed, inviolable, and hallowed ground.

  If I click on LOCATE, I can find “Chevalier Jackson, MD,” his name affixed to a virtual flag attached to a pushpin that points to the place where his bones reside. From this bird’s-eye cartographic view, set to the left of the Schuylkill Expressway, which resembles from this height an esophagus, to the right of which runs the Schuylkill River (as trachea), it would appear that Chevalier Jackson’s resting place is a lung. Chevalier Jackson is here, the flag insists, indexically; and if you want, by clicking on another part of the site, you can also see the mausoleum in which he is buried and details of its stain-glassed windows, carved with angels that watch over him.

  The burial site as Web site has also provided an alphabetized list of dead “notables,” but Chevalier Jackson does not appear among them. You can find a biographical sketch of him here, but, at the time of this writing, he is not searchable as noteworthy inside the index that highlights the inventor of Campbell’s condensed soup; the founder of Mother’s Day; John B. Stetson, the hat manufacturer; Alexander Calder, artist; Loren Eiseley, naturalist; the father of professional baseball; a survivor (in a manner of speaking) of the Titanic; and the father of scientific management himself, Frederick Winslow Taylor.

  I won’t be visiting Chevalier Jackson’s grave, because I know, and you know, that he’s not to be found there. His story and his legacy are housed in a collection of fbdies in the center of Philadelphia, in the Mütter Museum, where he also resides. But I have, as I have said, made a pilgrimage to his coat. I’d almost forgotten about it and was leaving, and the historian who’d been my guide, he too was bringing his workday to a close when I reminded him, “I’m sorry, but you said you had a coat of his? Might I see the coat before I leave?”

  “Ah, the coat, of course you can see the coat,” the keeper of the artifacts replies. And, from some place I cannot see, he brings out a black wool overcoat that he holds before me on a hanger. I don’t dare touch it; I stand before its bodiless mien and feel myself held inside a stillness it beholds as me.

  “So that’s the coat that once contained the body of the man,” I think. And then I really see it, because the thing about this coat is that it’s tiny, and Chevalier Jackson ordered his clothes two sizes too large. It’s not really a man’s coat at all; it’s a coat, cinched a bit at the waist, and shapely, a little dressy, suited to the contours of a boy.

  SELECT BIBLIOGRAPHY

  Abraham, Benjamin, and Adekola O. Alao. “An Unusual Foreign Body Ingestion in a Schizophrenic Patient: Case Report.” International Journal of Psychiatry in Medicine 35, no. 3 (2005): 313-18.

  Adityanjee, Yekeen, A. Aderibigbe, D. Theodoridis, and W. Victor R. Vieweg. “Dementia Praecox to Schizophrenia: The First 100 Years.” Psychiatry and Clinical Neurosciences 53, no. 4 (1999): 437-48.

  American Broncho-Esophagological Association. ABEA Spring 2009 Newsletter, www.abea.net/website/news/newsletter/index.html (accessed June 1, 2009).

  “American Epic of Attainment.” Etude 57 (Jan. 1939): 5-6.

  Armstrong, Tim. Modernism, Technology and the Body: A Cultural Study. London: Cambridge University Press, 1998.

  Ashton, Dore. A Joseph Cornell Album. New York : Da Capo Press, 1974.

  “Automobile Cancer Cause?” Science News-Letter 12, no. 332 (Aug. 20, 1927): 121.

  Aviv, Jonathan F. “Transnasal Esophagoscopy: State of the Art.” Otolaryngology—Head and Neck Surgery 153, no. 4 (October 2006): 616-19

  Bachman, J.P., Jr. “Where Miracles of Science are Commonplace: A Thousand Paths Converge at Dr. Jackson’s World-Famous Bronchoscopic Clinic, An Interview with Dr. Chevalier Jackson.” Revenue: The Magazine of Light, June 1930, 18-20.

  Baltzell, William. Interview by Andrew Spector, M.D., John Q. Adams Center for the History of Otolaryngology—Head and Neck Surgery, Philadelphia, PA, Nov. 18, 2004.

  Barnie, Doris D. “Twenty-Five Years Revisited.” Gastroenterology Nursing 23, no. 1 (2000): 10-14.

  Barnhill, John Finch. “Introduction of the Living Ex-Presidents of the American Lar yngological, Rhinological and Otological Society, Used in Introducing Each at a Dinner in their Honor.” Transactions of the American Laryngological, Rhinological, and Otological Society 34 (1928).

  Barta, Caroline M. “Peroral Endoscopy.” American Journal of Nursing 37, no. 11 (Nov. 1937): 1243-46.

  Bergner, Gwen. Taboo Subjects: Race, Sex, and Psychoanalysis. Minneapolis: University of Minnesota Press, 2005.

  Bigelow, F.S. “Why the Doctor Was So Sure.” Saturday Evening Post 208 (Aug. 1935).

  Black, R.E., D.G. Johnson, and M.E. Matlak. “Bronchoscopic Removal of Foreign Bodies in Children.” Journal of Pediatric Surgery 29 (1994): 682-84.

  Blakely, Robert L., and Judith M. Harrington, eds. Bones in the Basement: Postmortem Racism in Nineteenth-Century Medical Training. Washington: Smithsonian Institution Press, 1997.

  Blakeslee, Howard W. “Folks from All Over World Who’ve ‘Swallowed Something’ Beat a Path Here to Dr. Chevalier Jackson, 71-Year-Old Master of the Bronchoscope,” Philadelphia Bulletin, 1936.

  Blinder, Barton J., and Christina Salama. “An Update on Pica: Prevalence, Contributing Causes, and Treatment.” Psychiatric Times 25, no. 6 (May 1, 2008), www.psychiatrictimes.com/display/article/10168 (accessed May 10, 2010).

  Bondeson, Jan. The Two-Headed Boy and Other Medical Marvels. Ithaca: Cornell University Press, 2000.

  Botoman, V. Alin, and Maureen Botoman. “The First Dilation of a 60 Year Old Stricture: The Legacy of Chevalier Jackson—America’s First Endoscopist.” Abstracts of the Proceedings of the American College of Gastroenterology 70th Annual Scientific Meeting, 2005.

>   Boyd, Arthur D. “Chevalier Jackson: The Father of American Bronchoesophagoscopy.” Annals of Thoracic Surgery 57 (Feb. 1994): 502-5.

  Brandt, Doug. “Curiouser and Curiouser.” American Journal of Nursing 106, no. 8 (Aug. 2006): 37.

  Brody, Jane E. “For Some, All Food Is Hard to Swallow,” Spokane Chronicle, Jan. 23, 1989.

  ———. “When Swallowing Food Becomes a Problem.” New York Times, July 20, 2004.

  “Bronchoscopist.” Time, June 1936.

  “Bronchoscopist Jackson Retrieves Things Careless People Swallow.” Life, June 13, 1938.

  Bugbee, Joan Jackson, and Frank Bugbee. Interview conducted by Phillip R. Seitz, for John Q. Adams Center for the History of Otolaryngology—Head and Neck Surgery, Schwenksville, PA, July 31, 1991.

  Bulgakov, Mikhail. “The Steel Windpipe.” In A Country Doctor’s Notebook, 27-37. London: Harvill Press, 1995.

  Bundy, A.D. “Death from the Introduction of a Stomach Tube.” Medical Record 26 (1884): 504-5.

  Butler, Judith. Giving an Account of Oneself. New York: Fordham University Press, 2005.