Chevalier Jackson: father of endoscopic surgery, and champion of women in medicine, social justice, and public health

Abstract

Backgrounds: Chevalier Jackson (1865-1958) was a pioneering force in the medical world, whose extraordinary contributions to surgery and public health have left an indelible impact. He developed the endoscope and perfected the bronchoscope, and his mastery of these tools enabled him to transform the prognosis of foreign body aspiration from 98% mortality to 98% survival. He was also a passionate advocate of public health chairing the national committee on lye legislation, which culminated in the Caustic Poison Act, responsible for poison and antidote labels. Yet Jackson's accomplishments were not limited to these. The aim of this manuscript was to shed light on Chevalier Jackson's lesser-known contributions to surgical science and culture, and to celebrate and honor the life of this remarkable surgeon.

Methods: Digital and physical historical records from the National Library of Medicine, Smithsonian Institution, Heinz History Center in Pittsburgh PA, and Sunrise Mill Museum, Montgomery County PA were reviewed for Chevalier Jackson's scientific, cultural, and social contributions to the field of surgery.

Results: Among his lesser-known contributions, Chevalier Jackson was the first to describe erosive esophagitis. He developed the first standardized tracheotomy procedure, still in use today. He was ahead of his time in many ways, pioneering a multidisciplinary approach to medicine, advocating for patient-centered care, and advancing the inclusion of women in the medical profession.

Conclusion: Chevalier Jackson's legacy extends far beyond the tools and techniques he invented. He was a champion of social justice, a protector of patients, and an inspiration to medical professionals across the globe.

Keywords: Bronchoscopy; Chevalier Jackson; Endoscopy; Foreign body; History of medicine; Women in medicine.

Fig. 1

Chevalier Quixote Jackson MD FACS, at age 21, one-year after starting his practice in Pittsburgh at Western Pennsylvania Hospital (Left), and during his tenure as department chair at all 5 medical colleges in Philadelphia (Right). Photos obtained from The Life of Chevalier Jackson: An Autobiography. New York: The MacMillan Company; 1939. (Left) and Chevalier Jackson papers. 1890–1964. Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 292. (Right)

Fig. 2

Chevalier Jackson’s endoscope (A). Illustrations of the essential parts and direct vision inflating with a Brunnings handle lamp (B). Each instrument was shipped in a box with the mantra Chevalier learned from his father and shared with his trainees: “Educate the Eye and the Fingers” (C). Photos obtained from Chevalier Jackson papers. 1890–1964. Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 292

Fig. 3

Although, the initial prototypes for his endoscopes were built in a Pittsburgh workshop owned by one of his friends and a machinist, Andrew Lascher, once he moved to Sunrise Mill outside Philadelphia, Jackson used the gristmill as a workshop and art studio, as seen here building several different sized bronchoscopes, which are sitting on the table in the foreground. Photo obtained from The Life of Chevalier Jackson: An Autobiography. New York: The MacMillan Company; 1939

Fig. 4

Chevalier Jackson and the collection of 2,374 foreign bodies he personally removed from the airway and esophagus of patients. Photos obtained from Chevalier Jackson papers. 1890–1964. Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 292

Fig. 5

“The Old Man’s Garden” (1916) oil painting by Chevalier Jackson (Top Left). “Alice” (1912) by Chevalier Jackson (Top Right) an oil painting of his wife Alice Bennett White Jackson (1876–1957). Chevalier Jackson painting outside and inside his home at Sunrise Mill. Photos obtained from The Life of Chevalier Jackson: An Autobiography. New York: The MacMillan Company; 1939

Fig. 6

Chalk talk on tracheotomy. In the observation stand a group of physicians taking a bronchoscopic course. In the front from left to right: Chevalier L. Jackson, who followed his father into the field of esophagobronchoscopy; Dr. Penn Smith; Dr. Emily Van Loon, surgical trainee of Jackson who took over esophagobronchoscopy education at Woman’s Medical College after Chevalier Jackson; pediatric patients just treated holding a tracheotomy doll, which Jackson used to explain the procedure and teach the children to take care of their tracheotomies; and Chevalier Q. Jackson. Photo obtained from Chevalier Jackson papers. 1890–1964. Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 292

Fig. 7

Chevalier Jackson was an early practitioner of what would become known as patient-centered care, encouraging patients to be involved in their care, even teaching them to self-dilate their strictures. Here he is explaining a procedure to the patients, scope in his left hand (Bottom). Patients at Temple University Hospital whose larynxes had been partially destroyed by diphtheria, requiring tracheotomy, are ‘playing doctor,’ imitating Chevalier Jackson, down to his classic stance in the operating room, and learning from toys and dolls, all of which have also had a tracheotomy (Top). Photos obtained from Chevalier Jackson papers. 1890–1964. Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 292. (Bottom) and The Life of Chevalier Jackson: An Autobiography. New York: The MacMillan Company; 1939. (Top)

Fig. 8

Chevalier Jackson meeting with a 10 year-old patient before endoscopy to explain the procedure and show the patient the endoscope, which is held in his left hand (Left). Jackson’s taught surgical trainees through graduated autonomy in the operating room, as shown here overseeing a trainee’s technique (Right). Photos obtained from Chevalier Jackson papers. 1890–1964. Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 292

Fig. 9

Sixth Pan American Medical Congress, Havana, Cuba, 1928. In order from left to right, Dr. Leone Cottrell; Dr. Grace Ritchie-England; Dr. Frances B. Tyson; Dr. Chevalier Jackson, President of the Woman’s Medical College of Pennsylvania; Dr. Ellen J. Patterson, Chief of the Pittsburgh Endoscopy Clinic; Dr. Lydia A DeVilbiss; Dr. Virginia Van Meter and Dr. Jeannette Cohen. Photos obtained from The Life of Chevalier Jackson: An Autobiography. New York: The MacMillan Company; 1939

Fig. 10

Chevalier Jackson on a homemade boat in the pond at Sunrise Mill. The quote from his autobiography with his handwritten signature describes his deep love of nature and desire to live a peaceful life at home. Photos obtained from The Life of Chevalier Jackson: An Autobiography. New York: The MacMillan Company; 1939