Swallow by Mary Cappello: book review

Swallow: Foreign Bodies, their ingestion, inspiration, and the curious doctor who extracted them (2011) has a long title, and is indeed a lengthy book. It is about Dr Chevalier Quixote Jackson (1835-1958), a laryngologist who collected foreign items lodged in his patients’ air and body passages – mostly accidental, but sometimes accidentally on purpose, and at other times fully on purpose.

The doctor catalogued all the items extracted, which are now an exhibition at Philadelphia’s Mutter Museum, a repository of medical curiosities: bottle caps, pins, nails, wrist watches, padlocks, dolls’ eyes, metal whistles, live fish, cigarette butts, etc. This also includes items lodged in people’s noses. All of the items are kept in drawers and drawers within drawers.

Cappello includes information about the doctor’s collection and catalogue notes (although noted that while scrupulously catalogued, “so much is left out”). Jackson noted that when a foreign body (fbdy) had been swallowed, it resulted in “choking, gagging, coughing, and wheezing … regardless of the fbdy’s residence: lung, stomach, or throat.” He added, “laughter, sobbing, and crying … in addition to the altered inspiratory rhythm bring into play other movements” such as gasping and swallowing.

Jackson was a laryngologist at a time when medicine was evolving rapidly. At the beginning of his time as a doctor, surgery to extract an ingested foreign body resulted in death in 98% of cases. During his lifetime, Jackson reduced the number of deaths due to his new techniques - and instruments. He designed and made over 5,000 instruments, from forceps to bronchoscopes, endoscopes, and microscopic cameras. Each and every new foreign body posed a unique engineering problem to him.

An interesting fact is that more watermelon seeds are swallowed than inhaled [up the nose] but more get stuck in the airway than the foodway. And the combination of running, laughing, and eating can be deadly. And a woman who had over 500 pins in her stomach felt only “discomfort and slight pain.” Another person had 1,203 pieces of assorted hardware in her stomach in 1934, which the woman said she ate when depressed. Thinking and chewing seem to go hand in hand. And items seem to get stuck in the throat no matter if you cover your mouth while eating, or eat with your mouth open, or for quick chewers or slow eaters, quiet chewers or loud. Some items pass through the intestines to exit as bowel movements, while most items get stuck somewhere between the back of the throat and the gullet to the lungs and intestines.

Dr Jackson was so famous that people around the world called on his skills. In Australia, the Australian State Department planted a tree on the grounds of the Melbourne Boy’s High School in South Yarra in 1936 as official thanks to Chevalier Jackson in recognition of the time he removed a nail from the lung of three-year-old Kelvin Rodgers.

It is not a light read. However, the dense novel is not excessively scientific, as Cappello attempts to write about the events in layperson’s terms. She includes photographs from Jackson’s collection, but these are not good quality. Nevertheless, it is an interesting read.