Swallow: Foreign Bodies, Their Ingestion, Inspiration, and the Curious Doctor Who Extracted Them [Englisch] [Gebundene Ausgabe]

The Mütter Museum in Philadelphia has long been a site of pilgrimage for the unsqueamish who are interested in medical curiosities or just general freakishness. Under a stairway there is a cabinet with heavy drawers which visitors are invited to open. Within each drawer are further compartments, each of them containing a small object. The objects are not extraordinary, and they certainly are not as dramatic as some of the museum's other exhibits. There are coins, brooches, a steering wheel from a toy automobile, safety pins, a crucifix, a watch, a padlock, peanut kernels, a bullet, and hundreds more, objects of such diversity that it is hard to see what might unite them. These are, however, the Chevalier Jackson Foreign Body Collection. Dr. Jackson plucked the items from the interiors of bodies where they had no business being, from esophagi, stomachs, and bronchial tubes. He would have been distressed, perhaps, that they were curiosities in a museum which houses many monstrosities, for he had indexed each object with data about the age and sex of the person from which it was extracted, the procedure used, and so on. He said that the collection was, "in my opinion, of enormous clinical value to the physician and surgeon." Dr. Jackson had a mission, to increase doctors' understanding that people swallow or inhale such items with distressing frequency, and that such accidents need to be considered when any patient comes in with throat, chest, or stomach complaints. The story of Dr. Jackson and his collection is a strange one, oddities marshaled in the hope of relief of human suffering, and it is told with enthusiasm and admiration in _Swallow: Foreign Bodies, Their Ingestion, Inspiration, and the Curious Doctor Who Extracted Them_ (The New Press) by literary nonfiction writer Mary Cappello. It is a lovely union of the bizarre and the hopeful.

Chevalier Jackson was indeed a curious man in both senses of the term. He graduated from medical school in 1886. He was a flinty character who didn't smoke or drink, and who advised against the eating of peanuts because he knew how they gave a risk of sudden death. He treated Pittsburgh's urban poor and was far more interested in helping them than in getting paid for his services; he was rarely paid because most of his patients were "charity cases," although he did insist on keeping the extracted foreign body. This sometimes rankled the patient if the item was a coin. His work was influential and was revered by his peers, although they tended to find Jackson himself cold and even phobically unsociable. How did all that hardware get inside those bodies? Here is Jackson on one cause: "Putting inedible objects in your mouth increases your risk of choking." We use our mouths as third hands; who has not held tacks or safety pins (Dr. Jackson gleefully called these "danger pins") with the lips while the hands were busy elsewhere? A fall, a cough, a surprise, a moment of forgetfulness, and down they go. Then there are the more disturbing cases of malevolent parents or caretakers who had a pathological intent of making children swallow pins or stones. Less worrisome, although often still deeply weird, are the people who wanted to swallow objects. There are those who hysterically swallow or inhale tacks or other objects with the express purpose of enjoying the "sympathy" issued by those who will look after them. One lady depressed over her husband's death ate glass, a penny, and hairpins with the intent to end her life. A completely different category of metal-eater is that of sword swallowers, who also make money by making non-food items go down their guts. It was sword swallowers who taught physicians how the mouth, throat, and neck could be positioned to allow endoscopes to be lowered into useful working sites.

Probably Dr. Chevalier Jackson would have been impatient with a sword swallower because Jackson was constantly trying to reduce the risk of people putting dangerous things inside themselves. Nonetheless, his own career was built upon passing his instruments down inside them, and he was hugely successful at the art and the science of his work. He practiced with manikins and animals and never made an accidental perforation with the scopes he stuck into people. His survival rate of patients from whom he removed objects, often patients that no other doctor would risk touching, was better than 95%. And each object he took out took its place in his peculiar, fetishistic collection. Often poetic, Swallow is funny and repellant by turns, and fascinating throughout. It is a winning presentation about weird patients and the weird contents of their insides, and the weird doctor who worked so hard to bring the objects out and make an educational display of them.

A dazzling sketch of a pioneer doctor and the objects he retrieved from the bodies of his patients.

With the same care and precision Chevalier Jackson once exhibited within the human body, Cappello examines his work and what it means to be human, vulnerable, swimming in the reckless depth of every breath.

I would say this book offers a rich tapestry of thought that adds to our collective consciousness of medicine and magic. With a poet's sensibility, Cappello questions what few are willing to plummet. To read this work of nonfiction, "We might have to ask why we say we swallow our pride and not our envy, anger or greed." For this sentence and so many more, I am in wild admiration of this marvelous and powerful work.

To open this book called Swallow, we take an unflinching look within, to every beautiful and tender corridor.

In "Biography or Biographeme," which Mary Cappello posted as a guest blogger for Powell's Books, she explains that she was aiming for "an extended, deeply researched poem" with Swallow, as opposed to the "definitive" or "official" biography of Dr. Chevalier Jackson. I'm pleased to report that she succeeds on that score.

Throughout the book, Cappello capitalizes the word "thing" when it "refer[s] to an object that has undergone a transformation once it has been swallowed, retrieved, studied, and placed in Jackson's collection." I loved that in addition to detailing the metamorphoses of particular swallowed objects into Things, her supporting prose is full of this kind of magic. The esophagus and windpipe are not merely adjacent, they share a "party wall." A sword swallower becomes a "human sheath." A "knobless drawer" invokes "tight-lipped terror." Jackson, who could close a safety-pin lodged in a patient's esophagus, becomes a "time-bomb detonator."

I also enjoyed Jackson's own memorable analogies that Capello quotes, including his likening using a forceps to walking on stilts and his discussing a foreign body's position in terms of obstetrics.

Here's a passage on umbrella-headed tacks that Capello shares from Jackson's "Diseases of the Air and Food Passages of Foreign-Body Origin": "The umbrella-shaped head with its weighty stem for ballast certainly is well constructed for being drawn in by the inspiratory blast, like a parachute on a rising wind...This shape, as well as the point, resists bechic expulsion unless the tack is overturned; we all know the pull of an umbrella when the wind gets under it."

If a conventional biography is the play-by-play part of a sports broadcast on the radio, Swallow is not only the color commentary -- it's a layered, textured soundscape that includes vendors yelling "Programs! Get your programs!" or "Cotton candy!", the organist playing high-energy phrases, the crowd cheering, and maybe thunder in the distance.