History of Medicine

America’s First Bronchoscopist

     Imagine a young girl, perhaps 7 or 8 years old, pale, weak, and emaciated. Her distraught mother explains that weeks earlier, her daughter had swallowed lye, thinking it was sugar. The resultant scars in her esophagus, contracting inexorably, now placed her near death from starvation or dehydration. During much of the 19^th century most homes kept lye for making soap, and the jars did not carry danger labels. Other home accidents included aspirated or swallowed bones, safety pins, or coins, that might obstruct or perforate the esophagus or bronchial tree. Short of chest surgery, risky at the time, there was little relief available.

     To the rescue came the inventive Dr. Chevalier Jackson. Born in 1863, Jackson grew up on a poor farm near Pittsburgh.

Chevalier Jackson (Wellcome Library)

Valuing education, he worked his way through Western Pennsylvania University (now Univ of Pittsburgh) and entered Jefferson Medical College. He took an interest in laryngology, influenced by professors at the recently founded nose and throat clinic. In the library of one professor, Jackson read through the works of Sir Morrell MacKenzie, the father of laryngology in England. Determined to study with MacKenzie, he booked the cheapest steerage passage to England, requiring him to bring his own mattress for the assigned double-decker bunk. He stayed with MacKenzie only briefly, however, disappointed in the design of his esophagoscope.

     On return, in 1886, he opened an office in Pittsburgh, a coal town that was so sooty that the lights were often kept on throughout the day. Jackson’s new specialty of laryngology, fortunately, was publicized by news bulletins about the crown prince of Germany, the son-in-law of Queen Victoria, who had cancer of the larynx and on whom MacKenzie had consulted (see blog of 2/11/17).

     Jackson was busy very soon. Enlarged, chronically infected tonsils interfered with sleeping and breathing in those days, and he removed them from many poor public-school children, rarely receiving any payment. He also was adept at passing a tube through the larynx or doing tracheotomies in children with diphtheria (where an anesthetic was contraindicated). His inventive genius, however, found its greatest application while dealing with foreign bodies and lye burns of the esophagus. Within four years of arrival he had devised a new esophagoscope, with which he removed a “tooth plate” from the esophagus of an adult and a coin from that of a child. He reported the cases to the local medical society, only to learn of tragic outcomes in similar instances treated by his untrained colleagues. He refused henceforth to allow the instruments to be used without proper instruction in anatomy and practice on anesthetized dogs.

     When Jackson found he could dilate constricted esophagi with his instruments, unexpected numbers of emaciated children crowded his office. The numbers were so large that he initiated a crusade to have labels placed on containers with poisonous substances. Industrial resistance to labeling was fierce, however, and no such law was passed until 1927 – the Federal Caustic Poison Law.

     Meanwhile in Austria, in 1897, Dr. Gustav Killian, the “father of bronchoscopy”, made history by removing a piece of bone

Gustav Killian (Wikipedia)

from the bronchus of a farmer, using a rigid tube. Killian’s reports stimulated Jackson to devise his own “bronchoscope”, and, in so doing, he introduced bronchoscopy to America. Lighting in the distal end was adapted from cystoscopy techniques. Jackson’s rigid scope was used almost exclusively for foreign body retrieval and biopsies.

     Jackson continued to revise and perfect new models of his scopes. He was rigorous about requiring training for their use, and many of those he

Swallowed trinket embedded in a candy, X-ray by C. Jackson (Wikipedia Commons)

trained went on to teaching positions elsewhere. As his reputation spread, he was asked to demonstrate at conferences in major cities, including Paris. He bypassed London, however; England’s severe antivivisection laws prohibited endoscopy on dogs, even anesthetized ones.

     In 1916, he accepted the Chair of Laryngology at Jefferson Medical College in Philadelphia, and eventually held faculty positions simultaneously at five medical schools in Philadelphia. This broke exclusivity rules at most of the institutions, but regulations were bent to keep him aboard. His one stumbling block was tuberculosis, each of three episodes putting him at bedrest for months at a time. He used the idle time to

Title page of Jackson's text (Hathi Trust)

write a popular text on endoscopy, a revised edition for use as a manual, other texts, and many articles, 238 of which were single-authored. He was an editor of the Archives of Otolaryngology, wrote an
autobiography, and was a founder of the American College of Surgeons. In his lifetime he extracted from patients over 2000 foreign bodies, all in the Mütter Museum in Philadelphia.

     Beneath this busy and inventive exterior lay a humane and charitable soul. Chevalier Jackson maintained that ninety percent of his work with patients was gratis. He never patented any of his instruments, considering it immoral to profit from medical inventions. He was a vegetarian and attributed his unusually steady hand in bronchoscopy to his abstinence from alcohol and tobacco. He was an accomplished artist and woodworker. He died at his farm, Sunrise Mill, near Philadelphia, at the age of 93.

Sunrise Mill, now a historic site (Wikipedia)

SOURCES:

Jackson, C. The Life of Chevalier Jackson: An Autobiography. 1938; Macmillan, 1938.

Marsh, B R. “Historic development of bronchoesophagology”. Otolaryngology-Head and Neck Surgery, 1996; 114: 689-716.

Boyd, A D. “Chevalier Jackson: The father of American bronchoesophagoscopy”. 1994; Ann Thoracic Surg 57: 502-5.

Coates, G M. “Chevalier Jackson” (obit.) 1959; AMA Arch Otolaryng 69(3): 372-4.