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Originally published Tuesday, January 11, 2011 at 11:45 AM

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Down the hatch and straight into medical history

From brain tissue to gallstones, doctors have long preserved specimens from their patients — sometimes as trophies, sometimes as teaching tools, sometimes as curiosities or even art. But Dr. Chevalier Jackson went much further than most. A laryngologist who worked in the late 19th and early 20th centuries, he preserved more than 2,000 objects that people had swallowed or inhaled.

The New York Times

From brain tissue to gallstones, doctors have long preserved specimens from their patients — sometimes as trophies, sometimes as teaching tools, sometimes as curiosities or even art. But Dr. Chevalier Jackson went much further than most.

A laryngologist who worked in the late 19th and early 20th centuries, he preserved more than 2,000 objects that people had swallowed or inhaled: nails and bolts, miniature binoculars, a radiator key, a child's perfect-attendance pin, a medallion that says "Carry me for good luck."

Jackson retrieved these objects from people's upper torsos, generally with little or no anesthesia. He was so intent on assembling his collection that he once refused to return a swallowed quarter, even when its owner threatened his life.

"He was a fetishist, no question," said Mary Cappello, the author of "Swallow" (New Press), a new book about Jackson and his bizarre collection. "But his obsession had the effect of saving lives. That's kind of amazing, and lucky for us that his madness made possible forms of rescue."

Jackson was an artisan and a mechanical prodigy, a humanist and an ascetic whom colleagues sometimes described as aloof or cold. He spent hundreds of hours crushing peanuts with forceps to learn exactly how much pressure to exert. He experimented extensively on mannequins and dogs.

In those days surgery was associated with high mortality, and few physicians were willing or able to peer into the air and food passages, let alone remove objects like open safety pins. Yet Cappello writes that the survival rate among patients from whom he removed objects was better than 95 percent.

"If Jackson could tell us how he wished to be remembered, I'm certain he would do so by assemblage, or meaningful collage," said Cappello, an English professor at the University of Rhode Island. For him, collecting was a form of self-portraiture as well as a clinical and scientific pursuit.

Jackson viewed the world as a precarious place. Small and bookish as a child, he endured intense torment and bullying; at one point other children blindfolded him and threw him into a coal pit, and he was rescued only after a dog happened to find him unconscious.

So in a sense, Cappello said, when Jackson became a physician — first in Pittsburgh, then Philadelphia — he "was saving lives, yes, but he was also saving himself." He grew to be a pioneer of the upper body, developing new endoscopic techniques for peering into dark recesses.

He attached a tiny light called a mignon lamp to the end of a rod that he inserted into his scopes. (Previously, physicians who used endoscopes had worked mainly with light held outside the body.)

And he was an early and outspoken safety advocate, particularly when it came to children. As one of his assistants put it, his quest was to make the public and the medical profession "foreign-body-conscious" about swallowing.

If it had been up to him, Cappello said, "parents who fed peanuts to children without molars would be drawn and quartered." Chew everything thoroughly, he exhorted the public: "Chew your milk!"

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And he lobbied for passage of the Federal Caustic Poison Act of 1927, which required manufacturers to place warning labels on poisonous substances like lye, which burns the esophagus and causes severe scarring that can make it impossible to swallow.

Children often ingested lye because it was present in many households (where it was used to make soap) and because it looked like sugar.

A 7-year-old girl who could not swallow even a drop of water was taken to Jackson, who fed an endoscope into her esophagus and removed a grayish mass — perhaps food, perhaps dead tissue — with a forceps. Afterward, one of his assistants gave the child a glass of water.

"She took a small sip expecting it to choke her and come back up," Jackson recalled in his 1938 autobiography. "It went slowly down; she took another sip, and it went down. Then she gently moved aside the glass of water in the nurse's hand, took hold of my hand and kissed it."

Jackson also developed a technique for dilating the esophagus in children with scarring. He taught them to swallow a long tube and to do so regularly for an extended period. He suggested they might think of themselves as sword swallowers and imagine that the feat "inspires awe in other children." This eventually helped many of them to eat and drink again normally.

To remove objects like keys and coins and pins, Jackson would insert a long, rigid tube into his patients — usually children, and usually awake, though his assistants did help to hold them still. "He must have had an exquisite gentleness and ability to calm people," Cappello said. He also treated many poor children without pay.

Still, his eccentricities marked him. "Some people might have painted him as a socially phobic, friendless loner," she added. "He was not a warm and fuzzy doctor."

Nor would he compromise when it came to his collection.

In the case of that swallowed quarter, he told the patient's infuriated father that "all foreign bodies removed from the air and food passages were put into a scientific collection where they would be available to physicians working on the problems of relieving little children."

The father had beaten the boy as punishment, and when he didn't get the coin back he apparently beat him again, so viciously he broke his son's arm.

At that point Jackson gave the family a half dollar. But he did not return the swallowed coin.

The Jackson collection is now owned by the Mtter Museum of the College of Physicians of Philadelphia (www.collphyphil.org/Site/mutter_museum.html), which is refurbishing it for an exhibition that is to open Feb. 18. Cappello will help curate the exhibition; Anna Dhody, the museum's curator, called her work a substantial contribution that "we're very lucky to have."

Dr. V. Alin Botoman, a gastroenterologist at the University of Miami who has also done scholarly work on Jackson, called him "truly a renaissance man who made so many contributions to medicine and has been all but forgotten." Until now. In October, Cappello gave a lecture on Jackson at the Observatory, an art and events space in Brooklyn. She also presented black-and-white films from Jackson's family that had never been seen in public.

In a series of clips, Jackson is shown on a small boat, looking out at the sky. He is riding in the back of a pickup truck, writing intently.

His granddaughter, then a toddler, wobbles across a lawn holding a stuffed animal and a flower. She looks at the camera, shakes the flower and puts it in her mouth.

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