Swallow: Foreign Bodies, Their Ingestion, Inspiration, and the Curious Doctor Who Extracted Them (review)

Autobiographies by the men and women who inhabited the world of science at the turn of the twentieth century are often leavened by eccentricities that spring from fecund minds and often-solitary lives. In her biography of Chevalier Jackson, the author Mary Cappello captured the quirks, and the brilliance, of one of America’s most prolific, and obscure, medical pioneers. The book grew from an encounter the author had in the Mutter Museum of the College of the Physicians of Philadelphia with a collection of foreign bodies retrieved from the lungs, stomachs, and throats of people by Jackson, who then set about obsessively cataloging the objects. In Cappello’s hands, the objects tell the story of the man who removed them and of the world of medicine in the early-to-mid twentieth century.

Not, strictly speaking, an academic work, Swallow is scholarly in terms of its research. The author utilized not only the foreign body collection, but Jackson’s papers, Philadelphia newspapers, and assorted other archival material. Rather than frame her subject, Jackson, in a chronology of his life’s progression, Cappelo instead offers episodes from his life, all of which are linked, in some fashion, to objects in the collection. This is Cappello at her best, a simple pin or button, rescued from the innards of a suffering patient, initiates a journey that often moves from Jackson’s clinic in Philadelphia to his boyhood days as a bullied youth in late-nineteenth-century western Pennsylvania, and thence to a meditation concerning the mystery behind the physiology of swallowing. Cappello matched her narrative, at times disjointed, to the personality of her subject; one can almost feel the manner in which Jackson thought and acted through Cappello’s style, a factor sure to draw casual readers into her book.

Intertwined with her treatment of objects and Jackson’s life and work are deep plunges into Jackson’s psychology. Jackson was a bright boy tormented by the sons of coalminers in the small village where his parents ran a tavern. The beatings, some of them severe enough to render him unconscious, were a classic pitting of brutish instincts against a keen mind and gentle disposition. In every patient, especially the infants and children, one understands that Jackson rescued himself over and over, the pain and terror of his youth reflected in the pleading facial expressions (for many, speech was impossible because of their young age or the location of the lodged object) of his patients. Because many of his patients were poor, he asked only to keep the object he removed, a request which Jackson carried to the point of obsessively refusing to exchange a retrieved twenty-five cent piece for a new one offered by the patient because, of course, the new quarter had not been collected during a procedure. The reward, then, was twofold; pain and sometimes death were avoided while his collection grew, each removal a victory and each object tangible proof of his ascendancy over his painful youth and a mark of his standing amongst his peers.

Measured solely by the number of objects he removed—the people healed through his expertise—Jackson’s professional career was a smashing success. His, however, was not a career made in the privacy of clinic and office. Jackson lectured and wrote about the causes of foreign body cases and methods of resolving such cases. A crusader, he broadcast his assertion that foreign bodies must be ruled out during an initial patient evaluation just as other possible causes of pain and illness were routinely checked off by laryngologists and pulmonary specialists. Jackson’s views were bolstered by the number of objects he discovered and removed after having been lodged for months and sometimes years inside airways and the upper reaches of the digestive tract. He also, Cappello stressed, educated the public through broadsides and pamphlets designed to encourage thoughtful...