Bronchoscopist

Waiting in Philadelphia last week for famed Bronchoscopist Chevalier Jackson to haul a hooked dental bridge out of his gullet was a Detroit medical student. En route from Australia last week was a child from whose lung Dr. Jackson is expected to remove a foreign body. Shipped home fortnight ago from Philadelphia's Temple University Hospital, where Dr. Jackson operates, was the body of a Knoxville, Tenn. girl who had inhaled the brass cap of a lipstick. Knoxville bronchoscopists had failed to remove the obstruction from her left lung. A fatal abscess had developed before Dr. Jackson's staff could attempt removal.

Dr. Jackson, while not the first man to peer down the trachea and esophagus, perfected the circus sword-swallower's technique of throwing back the head so far that mouth, throat and windpipe or gullet form a straight channel through which a straight metal tube can be slipped. The tube which penetrates the windpipe to the lungs is called a bronchoscope. A slightly larger metal tube which goes into the gullet is Dr. Jackson's esophagoscope. At the tip of esophagoscope and bronchoscope is a small electric light by whose illumination the bronchoscopist can see any foreign body or diseased tissue of windpipe, bronchi or gullet. By means of slim, skillfully jointed tools which fit the bore of the metal tube, the bronchoscopist can usually catch hold of and pull out foreign bodies.

By 1917 Dr. Jackson's fame as a bronchoscopist had attracted so many doctors to his classes at Philadelphia's Jefferson and University of Pennsylvania medical schools that he had enough specialists in that new branch of surgery to form the American Bronchoscopic Society. This week that society, augmented to a membership of about 75 by graduates of Philadelphia's Temple University where Dr. Jackson now teaches, meets in Detroit for exchange of experiences of extracting tacks, pins, false teeth, bones, knickknacks from lung and gullet.

Dr. Jackson advises people with removable dental bridges or sets of false teeth to take them out of their mouths before going to sleep. "Some people are extremely sensitive about this," he once told a group of Philadelphia dentists, "and it is amazing the number of people who are annoyed when I suggest that they remove their dentures before retiring. . . . The chances of suffocation are not great. Occasionally a man has been asphyxiated by a denture or a tooth. But not nearly so often as by an oyster." The obstruction which Dr. Jackson has found most often in the gullet "is a certain part of the breastbone of chicken. Why, we don't know. But there's something about that bone which seems to make it lodge in the esophagus. It is a curious thing."

Last week Dr. Jackson and many another bronchoscopist were in Denver for a convention of the American Laryngological (throat), Rhinological (nose) & Otological (ear) Society. There Dr. Samuel Iglauer of Cincinnati told about a rare case of collapse of a lung caused by a blood clot plugging a bronchial tube. Dr. Iglauer, professor of otolaryngology in the University of Cincinnati, slipped a bronchoscope into the lung, extracted the clot, enabled the lung to function again.

Dr. Jackson, looking his 70 years, adjusted his bifocal spectacles, described his method of repairing a throat crushed and puckered by a blow, strangulation, fall, crash or gash: "We have gone to the iron foundry for mechanical aid in treating such cases. Iron is cast through the use of sand cores that have the shape of the desired casting. We need a core that has the shape of the normal larynx so that we can mold from the amorphous mass of shattered cartilage, torn tissue and blood clots the opening necessary for the normal functioning of the organ." To do that Dr. Jackson has a set of expansible soft rubber rods of graduated diameters. First he makes a hole through the base of the patient's neck into the windpipe. This permits the patient to breathe during the years which may be necessary to repair his throat. Dr. Jackson's first direct step is to compress a small-sized rubber form and insert it into the puckered throat. The rubber upon expanding stretches the throat slightly. Soon as the throat accommodates itself to the stretch. Dr. Jackson repeats the process by inserting a core of larger diameter. "The treatment," said he last week, "is highly successful with children. But it should never be undertaken unless the physician has the patience of Job."

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