Mary Cappello

by Swallow: Foreign Bodies

  Three scenes in particular return Jackson to his liquid, limp self, all of which treat of death—of a baby and a horse, of a rabbit, and of a boy—but it isn’t death itself that makes him cry. “The tearfulness and terror of my childhood,” one scene begins, “seem to have been concerned with the cruelty and my helplessness to stop it, rather than with the gruesomeness of the sights” (LCJ, 15). At the age of nine or ten, Jackson is sent by his mother to buy some eggs from the wife of a teamster. The woman, Mrs. Murphy, sends him with her son, Micky, to search out more eggs in the haymow, when the boys happen upon a horrifying sight: the Murphy’s baby lies on the floor of a stall near the hind feet of one of the horses, “evidently trampled to death.” The utterly gruesome sight of the baby—its crushed and oozing brains—neither frightens young Jackson nor draws forth tears from him. He proceeds calmly to speak to the horse in order to drag the baby out from behind its hooves. Young Jackson carries the dead body toward his friend Micky’s house, while Micky, overcome with guilt—he was supposed to be watching the smaller child—runs to get his mother. Jackson delivers the bundle of baby to its shrieking mother, then follows her command to find a doctor and a priest, while Micky is sent to wake his drunken father, asleep in a haymow not far from the spot where the baby was killed.

  And here the emotional grain of the experience roughens for Jackson to the point of pain, for, upon his return, he finds his friend Micky standing at the opening to the stall and watching as his drunk father proceeds to whiplash the “trembling, quivering, crouching horse tied up in the stall” (LCJ, 15). Jackson, who was “tearless up to this time . . . burst out crying and ran till [he] got out of earshot of the lashes, the curses, and the struggles in the stall” (LCJ, 15). Jackson’s recourse is to try to find his father, a trained veterinarian, who might be able to stop the “senseless cruelty.”

  One might pause here to remember Jackson’s near contemporary, the German philosopher Friedrich Nietzsche, throwing himself onto the neck of a horse as it was being flogged, and the way the scene is made into the precipitating stroke of Nietzsche’s descent into madness. One might recall any number of moments in the modernist pantheon too—crucial and cataclysmic episodes in the work of Dostoevsky or Kafka in which the sight of the beating of a horse by a human gives rise to a forever alienated male modernist self. In this same era, Freud wrote of adult fantasies so often recounted by his patients that he gave them their own titles, even their own genres: those fantasies in which “a child is being beaten.” Freud uses the frequency of such scenarios in his patients’ psychic life to remind us of two breaking (off) points in the lives of children: that moment when the child mind feels the smart of the betrayal of a parent (“He doesn’t really love me. He hates me.”), and the moment of stark recognition of an adult’s superior physical strength.

  Who can watch the struggle of the creature who is victim and not be flooded with grief and a commensurate will to act—not to be paralyzed but to be roused? If we found our friend standing back and merely watching such a scene, might we also imagine that he would be able to watch our own beating at the hands of adults? What’s instructive here is the sense of what Jackson can or cannot look on: cruelty is already impossible for him to look at, and it doubly blinds him by bringing forth tears. The ghastly thrashing, the confinement of the horse in the stable, the impossibility of escape is rife with helplessness, but it is a defenselessness somewhat distinct from the vulnerability that caused the baby’s death. The baby had neither the physical strength nor motor control to save itself, and the horse could not know it was killing a child. The death of a child by accident is sad, but it doesn’t make Chevalier Jackson cry. Witnessing the unguarded, drunken father beat the horse is something altogether different and altogether overwhelming.

  Continuing to explore “the character of the tearfulness of childhood” (LCJ, 18), Jackson recalls another tragedy with which he directly juxtaposes the earlier scene. Once again, he is sent on an errand, this time to gather strawberries, when he comes upon a beating scene. A teamster, driving a team of horses too hard, beats his son for not exerting enough strength and balance against the back brake of the cart as it is pulled quickly down the road. Jackson doesn’t know how the scene concludes because he is driven away in tears by the sight of the father striking the son on the head with his “big dirty opened hands” (LCJ, 16). Later the same day, he sees the same wagon with the boy back-driver speeding down a hill, but the task of managing the wagon overwhelms the boy, who topples in front of the rear wagon wheel to his death. Boy Jackson calmly commands the horses to stop. Their halting hooves back rear against the load pushing fast against them and make a horrific jumbling sound. The sight of Tommy Walsh’s body is as gruesome as the baby’s was, and Jackson describes it just as coldly, in the language of a horror story, the eyes “squeezed out of their sockets” (LCJ, 18). But the dead human body (even if mangled and that of a child) doesn’t elicit Jackson’s tears.

  Once again, he is sent off to fetch the town’s doctor, and once again the father is drunk when he should be grieving. Evidently, the father went directly to the tavern while Jackson was fetching the doctor, and he arrives drunk with the dead body of his son at the cottage where his wife will receive the news:

  To my dying day, I shall never forget the piercing, agonizing shriek of the poor mother as she lifted the handkerchief I had laid over Tommy’s ghastly, mangled face. Up to that time I had not shed a tear; there had been no fight, no struggle, no cruelty, no suffering. The boy had been killed before my eyes, but the death was obviously instantaneous and painless. But the anguish of that shrieking, sobbing, moaning mother, and her infliction, the helpless besotted father, were too much for me. I cried and sobbed all the way home; and even today, sixty-two years later, I gulp when I think of that wretched woman. (LCJ, 17)

  Jackson describes a world in which children are expected to have the physical strength of adults or the emotional strength the adults only feign (because the adults, after all, are weak), a world in which implicitly helpless children must learn to survive at the mercy of even more helpless adults. He paints a picture of his child self as strong beyond his years, for here is a boy with the courage and fortitude and maturity to be able to act in the face of violent death, yet he also has the capacity to feel profoundly the pain of others to the point of being awash in it—he is a boy who is easily invaded.

  All of this goes a long way toward establishing a groundwork of motivations for a later life devoted to rescuing children from accidents understood as the fault of their careless caretakers. And it explains his devotion to the creation of a different kind of mother in his relentlessly admonishing work, the call for a mother who doesn’t turn away when her child is in harm’s way. Resigned to the ineptitude and the hopelessness of fathers, Jackson seems unable to forgive the negligence of moms. But there is also a degree of protest in the pages of The Life of Chevalier Jackson against its author’s own capacity for aggression, as though the major impetus behind writing the book was for Jackson to defend himself against a false accusation—and here Nietzsche as interlocutor returns. In a Nietzschean vein, the question “Who was that man?” translates into “Were you the man? ”—were you the one responsible for the injury, the suffering, the inevitable pain? That’s Nietzsche’s account of the basis for modern self-consciousness, one with injury and punishment at its core, but it sounds as though it could be Jackson’s too.

  It is hard to imagine any person being able to put instruments down children’s throats on a daily basis or perform tracheotomies on them without anesthesia—even in the name of care—who would not experience guilt in the process. Jackson had to be bold and, if not violent, then violating in his work. In a word, the ability to save lives in such heroic ways requires a degree of aggression, an aggression that he at all costs denies in his autobiography. In which case, his autobiography can be understood as an alibi for his later practice.

  The conflict is apparent in the extraordinary outcome of one o
f Jackson’s first cases involving a child. “One cold, dark, blackish-snowy morning in Pittsburgh,” Jackson is assailed by a woman who tells him her husband is beating her child to death. When Jackson arrives on the scene, he realizes the girl is asphyxiating because of a “laryngeal obstruction” (LCJ, 98). He performs an emergency tracheotomy consisting of “two cuts in the front of the neck” (LCJ, 98), but before he can make the second cut, he is attacked by the girl’s drunken father. After the father is taken away, Jackson finishes his work; after administering artificial respiration to the girl, he observes that she begins to breathe again: “her lips moved, and she began to cry. Tears rolled down her cheeks” (LCJ, 98). The girl’s face, though, tells a mixed story of aggression in the black-and-blue marks that appear there, for when her face ceases to be blue due to lack of air, the bruises left by her father appear. And alongside those, one can only imagine the bruises left by rescue, of the surgeon’s knife. The story the girl tells when she can speak is that she hid the family’s last remaining dime in her mouth. She needed to buy bread with it so that her brother wouldn’t starve, but she knew her father wanted it for liquor. Seeing her secrete the dime inside her mouth, the father attempted extraction by choking. Jackson arrives to rescue the girl from choking by cutting.

  Thus Chevalier Jackson revisits the beating scenes of his own childhood and conquers his helplessness before them at the very site of hunger, speech, and breath: the maw. Jackson enters, and transforms tears of flight into a conjoined drowning. Together, he and his patients go down into an aqueous underworld. The patient kicks, quivers, struggles. He nearly suffocates by dint of Jackson’s endoscopic method, however gentle. His eyes produce tears—tears, sword swallowers tell us, are always the effect of anything forced down the throat. But these are not crying or weeping or “physic tears,” the biology of which is also a psychology of affect barely understood by we who shed them. Are these then “reflex tears,” like those produced by an irritant in the eye, an onion, say? Or “basal tears,” the lubricating solution that at all times prevents the eyes from drying out? No, the tears produced by forced ingestion must be a different kind of tears for which there is no name. The body turned inside out, a part of it seeping. The work Jackson does with his patients requires that they go under together—down, down, down—while staying awake; together they sub-merge, they suffocate, they drown, but with the courage to stay long enough, they find the foreign body lodged in them, released. They cry.

  I gulp. He gulps. We gulp. To cry is to swallow. To swallow is to refuse to cry. Crying can make it hard to breathe, or swallow.

  Fbdy (Multiple) #1173; Gavage: The Case of Joseph B.

  Confronted by the fbdy collection’s overwhelming scale, stirred and stunned by the volume it affords, visitors to the Mütter Museum find themselves asking a particular kind of question, a genre of inquiry on par with Guinness Book extremes: What was the strangest thing ever swallowed? Or the largest? How much money in all was collected from people’s stomachs? What was the greatest number of things consumed by one person? Eyes widen and the mouth widens too to articulate the inarticulable, as though we’re assembled en masse before a county fair’s contest for whose stomach can receive the largest amount of pie. “Wow!” we hear ourselves saying, “Wow!”

  Jackson, too, wasn’t beyond identifying or delineating cases from the point of view of extremes, or what surgeon/writer Sherwin Nuland, in his book on medical myths, refers to as “the real rarae aves” (rare birds), “the one and onlies,” novelty cases, peculiar phenomena, “wonders of wonders,” that test the physician’s confidence and skill in unpredictable ways, “oddities” mentioned in passing in medical school but that no doctor ever truly expects to encounter, treat, or solve. Nuland’s example of the mystery case par excellence is none other than an unidentifiable stomach mass: a bezoar, or foreign body that forms as the result of an indigestible material held up in the stomach and unable to pass into the small intestine. Retrieving such masses from animal stomachs, humans have treated them as talismans. Inspiring equally fanciful responses, even if its origin bespeaks a person’s severe distress, the bezoar most commonly found in humans consists of (ingested) human hair; in the medical realm, they call it the Rapunzel syndrome.

  As we have already discovered, the ingested foreign body sends us to search out nothing so fervently as its origins. In the case Nuland recounts of a baby who had a ball of indigestible wax in his stomach, the origin of the “incomprehensible clump” “was not known” and “could not be imagined.” The question remains, though, what we hope to find in our search for origins. What exactly do we want to solve, resolve, answer? Do we defer resolution and opt instead for a domino effect of infinite surprise—an orgasm of Wow? What if it’s truth that draws us? Are amazement and a desire to know the truth mutually exclusive? And what constrains, determines, or necessitates our disclosure of the -est: the largest, strangest, most mysterious Thing?

  It probably comes as no surprise that the extreme that most interests Jackson is one that privileges the operator’s ingeniousness and skill. In other words, if Jackson is going to participate in a discourse of foreign body extremes, he will do so at the level of the most difficult case. Two cases jockey for this position from among the thousands, and though neither is interchangeable with the other, each is as interesting for what Jackson reveals about it as it is disturbing for what he leaves out—we might even go so far as to say for what he misreports about it.

  The two cases, each coincidentally involving a nine-month-old child and a grouping of safety pins, are cross-referenced in Diseases of the Air and Food Passages of Foreign-Body Origin in shadowy reproductions of X-rays of the objects in situ alongside still shots of the objects dredged and excised, glimmering now in the light of day (DAFP, 157-58, 250-51). The first case, fbdy#1071—which is granted absolute pride of place by its additional and singular inclusion among photos depicting Jackson’s life course in his Life of Chevalier Jackson—consists of

  four large, stiff, interlocked safety-pins impacted in the esophagus of a child, aged nine months. In addition to the interlocking and impaction from one month’s sojourn the pins were bound together with an entangled mass of wool. The problem was rendered still more difficult by the enormous size of the pins and the small size of the passages in a nine-month-old baby. (DAFP, 250)

  The four pins, splayed, fully open, and pointing upward, appear to dwarf the baby’s ribs in the X-ray, and the image is nearly overwhelming as a representation of that which does not belong, as a record of an uncanny disconnect between a body’s interior and a piece of the world trapped therein, between substance and context, stuff and location, the this and the there (see figure 20).

  It took Jackson an inordinately long time to extract the pins in three separate attempts lasting thirty-six minutes, twenty-four minutes, and nineteen minutes. The feat is barely imaginable, and one can understand why he considered it his most difficult case. He first had to disentangle the pins without harming the child using an instrument the size of a straw. Then, relying on a retrograde method that I’m certain must have severely strained his confidence, he was forced to place the two lowermost pins into the baby’s stomach, later to recover them in the baby’s stools. Then he closed and removed the two uppermost pins by his more regular peroral method—through the mouth. The case is neatly horrific, and he uses it again in his autobiography to teach by reproof, captioning photos of the X-ray and the four pins, which he reunited after the fact of their separation, covering over what he might have experienced as a failure tucked inside a success, with the lines:

  That the problem of the safe removal of this entangled mass of huge safety pins was solved does not alter the fact that when a nine-months old baby gets an opportunity to swallow such objects, some one was careless. It is a platitude to say that prevention is better than cure. (LCJ, penultimate illustration)

  Fig. 20. An X-ray revealing the appallingly daunting case #1071, which Jackson described as his most difficult c
ase.

  In a 1936 interview for Energine Newsreel, he had also put the case this way, noting that the fact that these “sharp, stabbing, potentially fatal pins were removed harmlessly and bloodlessly, through the mouth, does not alter the other fact that a nine-month-old baby could not walk to get the pins; someone must have left them within his reach. And worse yet, they left the pins open.”

  And here is where we must pause in a perusal of Jackson’s most difficult case. Did Jackson forget entirely a significant detail of this case or just blithely ignore it as “no matter,” because Emily van Loon supplies a missing detail that undoes carelessness as cause and replaces it with will-fulness. “Probably his most difficult case,” she reports in a tribute to him as president of the Woman’s Medical College, “was in a nine-months-old baby whose older sister had fed him four open safety pins entwined with strands of wool” (italics mine). (As if case #1071 were not uncanny enough, serendipity also played a part in this child’s treatment and cure. In one textbook caption, Chevalier Jackson explains that the baby had been admitted to the hospital for “operation for phimosis” or nonretractile foreskin, a condition which may or may not be pathological in infants, but that a nurse happened to find a safety pin in the baby’s stool. This led to the decision to take X-rays, which then revealed the pins in his throat [DAFP, 124].

  If human psychology cannot enter into Jackson’s accounts of his most difficult case, it is because such admission would require him to revisit the scenes of his own childhood trauma. Maybe Jackson does not present all of the facts in the case, maybe he retreats again into carelessness as alibi because, while he can prevent certain forms of neglect by encouraging vigilance, he cannot, as his own life demonstrates, prevent violence. Jackson uses the verb “place” to describe his procedure with this nine-month-old baby, but no matter with what delicacy Jackson’s angel fingers might move, I don’t think that “place” accurately describes what he was forced to do with those bottom two pins: “push” might be more accurate. He was required to push the pins into the baby’s stomach, to complete the act of (force)-feeding initiated by the child’s sister.