The inside story on ingested foreign bodiesBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4213 (Published 06 July 2011) Cite this as: BMJ 2011;343:d4213
- Eamonn Clarke, general practitioner, Norfolk
Most doctors have a tale of an unusual foreign body retrieved from a patient. Few, however, can rival the record of the American laryngologist Chevalier Jackson. Between 1886 and 1930 Jackson removed more than 2000 objects from the upper airways, lungs, and gastrointestinal tracts of his patients. All of the foreign bodies were retained, carefully catalogued, and later donated to the Mütter medical museum in Philadelphia. He redesigned rigid bronchoscopes and gastroscopes and invented many of the tools he used to snare the foreign bodies. Yet he declined opportunities to patent his inventions, preferring to share his skills and tools with his students.
Many of his patients were children and most underwent endoscopy with no anaesthetic other than a cocaine throat spray. Jackson used a darkened operating room and his own calm and steady voice to reassure his frightened patients. The survival rate for his procedures was over 95%, including patients who had been turned away by other doctors. He was rarely paid for this service as most of the patients were so called charity cases. Instead he insisted on keeping the retrieved foreign bodies for his collection, even if the patient asked for them back. This occasionally provoked vigorous disagreements, especially if the item was a coin.
Jackson campaigned to spread awareness of the hazards of ingesting foreign bodies and corrosive liquids. At the time, lye, or caustic soda, was found in many kitchens, and sometimes ingested by children as the crystals resembled sugar. Jackson treated many children for the resulting oesophageal strictures and taught them to swallow dilators using techniques he learnt from sword swallowers.
Jackson’s life and the collection of foreign bodies is examined by Mary Cappello, a professor of English who stumbled over the collection on a visit to the Mütter Museum. She finds art in Jackson’s work and takes a poetic approach in her analysis, searching for meaning in the act of swallowing or inhaling these objects. How could a baby swallow four open safety pins? What leads some patients to repeatedly ingest a variety of bizarre items? Cappello muses on the act of swallowing and leads us to reconsider the apparently simple acts of eating or breathing and the anatomical and physiological tricks we use to separate food and fluid from air.
The result is a fascinating medical history. We follow many of Jackson’s cases and wonder over the bizarre objects lodged within them, and at the surgeon’s skill in removing them using tiny scopes and tools. Often he would practise on animals or dummies before going on to successfully remove an open safety pin or a collar stud from a child’s body. Cappello takes us back to Jackson’s own difficult childhood and wonders if events from his past triggered his interest in choking and his perfectionist approach to his chosen art.
It is common parlance to say that we are “choked up” when feeling strong emotions, and at times I could feel a lump developing in my throat as I read about patients who were unable to swallow. In one of the described cases Jackson removed a thick mucous plug from the oesophageal stricture of a child who had been unable to drink for days. After the procedure she took a drink of water and then reached for Jackson’s hand and kissed it.
As an operator Chevalier Jackson was second to none in his fastidiousness and preparation. He followed similar principles in his personal life, denying himself many of life’s pleasures in his dedication to his job. It is difficult to read this book without comparing ourselves as doctors to Jackson’s devotion to his patients and his art. I wondered how often I had discussed the hazards of choking with parents of young children, and whether I had missed cases of foreign bodies. It comes as a small relief to learn that Jackson could be a somewhat difficult character to get on with. Perhaps such genius comes at a cost, as Jackson seems to have had little time for his fellow men and women unless they had some unusual item lodged in a tricky recess.
The book is also not entirely perfect. Cappello’s use of poetic language and the jargon of critical theory is rather dense in places. Some patients’ names appear to be in the public domain and are used frequently, which caused me some unease. One of the images reproduced in the book repeats the common lay error of displaying a chest x ray the wrong way round. But if television and film cannot get this right why should we expect an English professor (or a publisher’s copy editor) to do so? In fact this charming error only serves to remind us of our profession and our links, however distant, to Jackson and his work.
Cappello’s account of Chevalier Jackson’s life and works takes us on a journey into the dark recesses of the human body to discover the strange objects placed there, often for very unusual reasons. It is full of curiosities, not least those of the doctor himself, who collected the items and arranged them into educational displays.
Cite this as: BMJ 2011;343:d4213
Swallow: Foreign Bodies, Their Ingestion, Inspiration, and the Curious Doctor who Extracted Them
The New Press, £19.99, 336 pages