Against All Odds: Chevalier Jackson, Physician and Painter

After he had observed his seventieth birth­day, Dr. Chevalier Jackson described downtown Pittsburgh of 1865, his birthplace, as dark, gloomy, and dirty. His recollec­tions of 1888, the year he es­tablished a medical practice in an old tailor shop on Sixth Avenue, were particularly vivid.

All winter long we lived as in a dark, cold, damp cellar. The sun was visible, on an average, four days in a winter month …. Soot, grime and black dirt covered everything, so that every time anything was touched the hands had to be washed. Every cleanly Pittsburgher learned not to touch his face …. The contrast with my white-marble-step college days in the then anthracite-burning Phil­adelphia was strong. But it was not alone and directly that the dismal dirt was depressing …. Artificial light was necessary all day long … falling black soot and grime necessitated the constant services of a charwoman …. Laun­dry bills were large.

Intense human interaction characterized the anecdotes he recalled from childhood in the Pittsburgh area, and he dwelt on the aggressiveness – rising even to violence – of the soci­ety of his youth. As a child he saw another boy crushed to death by the rear wheels of his own father’s freight wagon. He recalled wagon horses sunk to their knees in mud and whipped mercilessly by driv­ers, who were drunk, until blood filled the holes in which their legs were trapped. He felt the humiliation pressed on his father who had been forced to turn the family’s Greenwood home into a hotel. William Stanford Jackson, cattle dealer and veterinarian, had lost his business because of a dishon­est employee and was too proud to dodge creditors. The roughness of the industrial workers in the Jacksons’ neigh­borhood left the child with bitter memories of laborers who starved and beat wives and children who stood in the way of an evening’s drink. But there were also bittersweet memories, written after he had been internationally hailed for his own success.

In the worst of his boyhood crises it was the voice of a coal miner cursing and threatening his runaway dog that meant young Chevalier Jackson had been found and spared death. The incident took place when schoolmates blindfolded, bound, and abandoned him in a deserted coal mine. By chance the dog found the helpless boy, and his pursuing master rescued Jackson.

Without so much as stylistic deference to Divine Provi­dence, the elderly Jackson recounted the factors that led him to a medical career and to the bronchoscopic and esopha­goscopic specialization for which he became famous. When he wrote his memoirs in the late 1930s, autobiographies of American physicians were much in vogue. It was a time when American medicine seemed to be making rapid progress, and military heroics had temporarily declined in popular appeal. Similarly, and quite naturally, stories of achievement in business and industry had lost their popu­larity during the era of the Great Depression.

H. Sinclair Lewis’ 1924 novel, Arrowsmith, had prompted the public to reeval­uate medical morality and the inevitability of changes brought about by scientific medical research. An American Doctor’s Odyssey (1936) was the best-selling autobiography of Dr. Victor Heiser whose life had been shaped by the Johns­town Flood of 1889. The drowning of his parents and the catastrophe he witnessed changed him forever. Discover­ing personal skills in his teens, first as a plumber and then in carpentry, Heiser finally re­ceived money from his par­ents’ estate and became an engineering student. An inner voice, however, told him that a satisfying career must include service to society and, with typically brassy aggressive­ness, he advanced through Jefferson Medical College in Philadelphia. As a principal founder of the United States Public Health Service, he was concerned with preventing epidemics – potential catastro­phes in every sense compara­ble to the Johnstown Flood.

Appearing on the same late 1938 bestseller lists with Jack­son’s autobiography was not only Dr. A. J. Cronin’s novel about British medicine, The Citadel, but also Dr. William M. Macartney’s autobiography, Fifty Years A Country Doctor. If Lewis’ Arrowsmith had even­tually found contentment in pure medical research, both Cronin’s hero and Macartney were not content with lucrative surgical careers. Both returned to simple situations, serving the everyday community, including patients who could pay little or nothing. Review­ers of Macartney’s book ex­pressed astonishment at the extent of scientific information that a supposedly “simple” country doctor employed in his daily routine. America’s image of a general practitioner and family physician was being altered in no insignifi­cant way.

Guided by his father and a maternal uncle, a mechanic, the frail Chevalier Jackson spent much time in the fami­ly’s basement workshop, sur­rounded by tools and materials, where he could draw and learn to paint. His early efforts at building and inventing were followed by a passion for drawing, rein­forced by courses at the University of Western Pennsylvania. Jackson earned money to pay his way at Jefferson Medical College by decorating lamp shades at a factory in Pittsburgh, where he was paid for the number of pieces com­pleted each day. Wildlife and nature were his trademark themes. Later, art became for Jackson both a relaxing avoca­tion and a useful skill which he applied to medical illustra­tion. His drawings appeared in medical books and were used to reinforce his lectures, some­times drawn before the stu­dents’ eyes. He associated the manual dexterity necessary for art work with the skill required to successfully operate esphoa­goscopes and bronchoscopes. In addition to his drawing lessons in college, Jackson studied under a Pittsburgh landscape and portrait artist, A. Bryan Wall, the son of an English-born landscape artist. Jackson kept up membership in the Pittsburgh Artists’ Asso­ciation, and in his 1938 autobi­ography referred with pride to a few prizes he had been awarded.

Exclusive of his medical illustrations, meant to be abso­lutely precise images, Jack­son’s pictures in oil and chalk are impressionist in style and feeling. His many pen and ink drawings, as well as dry point etchings, may be considered philosophically impressionis­tic. Such paintings as October: Kilbuck Run, Ohio River Hills (1914), and Old Man’s Garden, Ohio River Bank (1916), are scenes of rural western Penn­sylvania. Brookline Bridge, Old Apple Trees, Old Sunrise Mill, and October, Old Sunrise Mill, all executed in chalk about 1920, clearly emphasize cloud­-filled skies and light on water. Alice and The Old Shoe: Ohio River Hills, both painted in 1912, reflect Jackson’s life cri­ses. Alice is not a facial portrait of his wife, Alice Bennett White Jackson, but a depiction of her with her head obscured by a large casual hat, seated and sewing – presumably repairing Chevalier’s shabby suits because he had no money to buy new ones. The Old Shoe was the home on the Ohio River where he reclined and slept year-round on an open porch to recuperate from tuberculosis. Many of his works reflect a respect for other people’s worlds. From the Car Window (1932) is a Mexican landscape, complete with giant cactus and sombreroed horseman, drawn while re­turning from a medical confer­ence in Mexico City. The Millwright (1916) symbolizes generations of unknown craftsmen who had labored since the construction in 1765 of Sunrise Mill, the structure the Jacksons renovated to make their home after they moved to eastern Pennsylva­nia. He furnished the work area of the old mill with wood­working tools and created many decorative pieces, re­newing a skill he had devel­oped in his father’s basement.

Chevalier Jackson could not bring himself to depict down­town scenes in Pittsburgh because to him it was always unattractive, but he relished Philadelphia neighborhoods and buildings for his works of art. His Philadelphia dry point etchings included Ivied Walls, a scene of the University of Pennsylvania campus with an emphasis on the distinctive collegiate gothic architecture wrapped in trailing vines of ivy, and A Bit of Old Blockley, a visual memoir of Blockley Hospital, the city’s charity ward which he had known well in his student days. Ironi­cally, he later learned he had drawn the very arch through which the great Dr. William Osler had passed daily during his rounds.

Jackson spent two years at Jefferson Medical College, living extremely frugally, and graduating in 1886, a few months before his twenty-first birthday. He particularly ad­mired one instructor, Dr. Julius da Silva Solis Cohen, a sur­geon who had been practicing since the Civil War. The profes­sor had invoked the wrath of the medical profession by daring to call himself a special­ist in nose and throat condi­tions. Professional standards of the period specified that medical doctors present them­selves as omnicompetent (with ophthalmologists the only rec­ognized exception). Jackson, intrigued by the prospects of developing treatments for internal illnesses by methods other than gruesome surgery and “heroic doses” of chemi­cals, learned principles of laryngology from his mentor.

Just emerging during the 1880s was the field of “laryn­goscopy,” the treatment of the larynx by an examining instru­ment, an endoscope for that specialty called a laryngo­scope. Esophagoscopy and bronchoscopy (for the esopha­gus and the bronchial tubes) were virtually unknown. Fol­lowing graduation from Jeffer­son Medical College, Jackson visited – at the suggestion of Dr. Solis Cohen – the London throat hospital of Dr. Morrell Mackenzie, then regarded as the world’s leading laryngolo­gist. Ironically, the following year Mackenzie confronted and failed in his greatest pro­fessional challenge: the treat­ment of the terminally ill German Emperor Frederick III. The ruler’s death placed the entire field of laryngology in an unfavorable light. For years some argued that Mackenzie’s unwillingness to risk a com­plete removal of a growth on Frederick’s vocal cord made death from cancer inevitable. Literature followed the emper­or’s death, giving statistics for operations on the throat, esophagus, and bronchial area, and showing that it was at least as dangerous for pa­tients with conditions in those areas to undergo surgery as to go without it.

Nevertheless, Jackson opened a laryngology practice in Pittsburgh. Realizing that the extended laryngoscope that Mackenzie used as an esophagoscope was virtually useless, Jackson designed his own version and with it re­moved a dental plate that had been swallowed by an adult. He also retrieved a coin from the esophagus of a child. In 1890 he publicized his instru­ment and encouraged its du­plication. Unfortunately, physicians who lacked his technique severely injured a number of patients, and the instrument was widely condemned.

Despite the critics, Pitts­burgh’s most difficult throat, bronchial, and esophagus cases were referred to Jackson, which left him little time for the routine tonsil and intuba­tion cases that were the main­stays of laryngologists. Several years later in New York, Dr. Joseph O’Dwyer developed tracheal intubation to prevent diphtheria from asphyxiating those who had the disease, a major medical advance which eliminated the need for surgi­cal tracheotomy. A tra­cheotomy permanently disfigured the throat; often it remained open for the rest of the patient’s life. Using crude instruments two German physicians began to reach into the bronchial area, and in 1898 a Boston physician removed an object from a main stem bron­chus using a urethroscope (an instrument actually intended for insertion in the urethra). Meanwhile, Dr. Max Einhorn developed the distal light – a small electric bulb held at the furthest point of the instrument – for cystoscopes (instruments to examine the bladder and the ureter). Jack­son adapted the light to the esophagoscope and the bron­choscope by 1902, a major breakthrough, and he added an aspiration tube to remove obstructing fluid. The chal­lenge of the esophagus was its soft, wrinkled, and collapsing structure which the esopha­goscope had to hold open by dilation. The challenge in working in the bronchial area was the intricate network of tubes – damage to any one of which could be fatal. A suc­cessful bronchoscope had to be much thinner at its working end than an esophagoscope, and required more manipula­tion. By using appropriate materials, increasing mechani­cal leverage, and making the instrument parts very small, Jackson made bronchoscopes achieve much more than the Germans. And by developing manipulative techniques by operating on anesthetized dogs – to the horror of canine fanciers – he acquired the skill to reach most bronchial recesses.

Toward the end of the first decade of this century Cheva­lier Jackson was the leader in two areas of peroral (“through the mouth”) endoscopy: bron­choscopy and esophagoscopy. Later he designed a superior laryngoscope. He was also recognized for work in gastro­enterology involving use of the gastroscope, although Dr. Rudolf Schindler was the major innovator in the field. Instruments bearing Jackson’s name became recognized as state of the art. He devised a myriad of specialized exten­sions and adapters, fashioning many of the prototypes him­self in his home workshop at the old mill. His creations included forceps, dilators, probes, syringes, and sponge holders. Since many of the swallowed foreign object cases were emergency situations, he developed a portable battery system. For infants he devel­oped miniature versions of the instruments. With his artistic skill he accurately depicted the appearance of the internal areas of living bodies, prepar­ing other physicians for the challenges they would encoun­ter. A professorship at the Pittsburgh Medical School and the directorship of a Broncho­scopic Clinic at Pittsburgh’s Children’s Hospital were given to him. In 1907 he published his first full length text on bronchoscopy and esophagoscopy.

In spite of his success, Jackson believed he could only continue by living extremely frugally. Although he under­took the most difficult peroral work in Pittsburgh, the proce­dure did not pay as well as routine work such as tonsillec­tomies because it involved a great number of charity cases. His unwillingness to press marginally low income patients – and some obviously niggardly patients – who could have made some payments was, he felt, a serious charac­ter weakness, one that haunted him through life. On Christmas Day in 1889 his father had died of heart failure at the age of sixty, leaving enormous debts because he had been the victim of embez­zlement years before. His father’s untimely demise con­vinced Jackson that he himself had inherited a weak heart. Furthermore, his penniless mother became his responsibility.

In 1899 Chevalier Jackson was doing well enough that he married Alice Bennett White, the sister of one of his pa­tients. It was an idyllic mar­riage and she seemed to be what he admired in a home­maker. Their only child, Chevalier Lawrence Jackson, destined to follow his father into peroral medicine, was born the following year. In 1911, however, Jackson was unexpectedly forced to change his lifestyle permanently when he fell ill with the first of three attacks of pulmonary tubercu­losis. For the first year of the illness he stopped practicing and confined himself to bed in his Pittsburgh home, spending time painting lamp shades for the lamp factory because he was so uncertain about the future. Alice found a house on the Ohio River where her husband could sleep through even the coldest winter weather with the windows open. His self-imposed regi­men of fresh air, extended daily rest, red meat, and milk cured him, even though he later suffered two severe relapses.

Gradually Jackson resumed his practice. He preserved several scenes of the river bank area, including the open-air house the couple named “the Old Shoe.” A piece entitled Mother – captioned “At the open window. She was always like a mother to me.” – illustrated his autobiography. Ostensibly a portrait of his mother-in-law, Mother may also have symbolized the open aiI therapy that had restored his health.

Jackson believed that most worldly callings served a pur­pose in society, excepting employment associated with the consumption of liquor. Politicians, however, might be good or evil; during his Pitts­burgh years the Republican boss Christopher Magee twice rebuffed Jackson’s pleas on behalf of children. Jackson approached Magee because his father had once provided the politician with a wagon and team for political campaigning. He believed that the city’s foul air threatened youngsters, and he first sought help to impose mandatory tonsil examinations for children through the public school system. Later he asked Magee’s support for state legislation to require poison labels on bottles containing lye, a common – but extremely dangerous – household cleanser. Lye’s resemblance to sugar led children to sneak up to the container and swallow what they thought would create an instant of happiness. Instead, lye burned throat passages, causing a swelling that made drinking impossible and many victims died of dehydration. The tenderest of Jackson’s many stories about sick children was of a lye vic­tim, a desperately dehydrated young girl who, after Jackson applied his esophascope, could not believe she could again swallow. She immedi­ately put down her water glass and took and kissed his hand.

On both occasions Chris­topher Magee advised the doctor that his cause was worthwhile, but that money alone could sway the legal authorities – not the sort of money that a laryngologist spending most of his time on charity patients could provide. It was only after eleven years in Philadelphia that Jackson, with the support of powerful humanitarians, brought about the Federal Caustic Substance Labelling Act. Jackson’s role was offering Congress con­vincing medical evidence.

In 1915, Jackson published his most significant book, Peroral Endoscopy and Laryngeal Surgery, largely the product of the many hours of forced confinement at the Old Shoe. In it he explained the nuances of surgery by means of endo­scopes and included many of the illustrations made in his clinic at Children’s Hospital. The contortions necessary to manipulate the instruments remain apparent from the still pictures, suggesting impecca­ble timing and adroitness. In order to perform these mo­tions he later trained himself, through drawing, to work ambidextrously. In one grim chapter Jackson analyzed five cases where attempts to re­move foreign bodies from patients had failed. Most of these involved straight pins swallowed by accident which had lodged in bronchial tubes. Even though they could be seen with X-rays, the objects were either deeper than the instruments could reach or Jackson was unable to make physical contact. One patient died following the conven­tional alternative procedure, attempted removal by direct incision with a scalpel, and another died when he refused the operation. However, at the time the book was printed one patient still hoped for recovery because the pin seemed to be miraculously working its way out by itself. Jackson included these reports because he wanted the medical commu­nity to understand the dangers of endoscopy, hoping never to repeat the catastrophe that had followed his first enthusiasm for the esophagoscope in 1890.

Although his Pittsburgh Bronchoscopic Clinic had acquired international renown, Jackson moved his practice and his family to Philadelphia and was appointed to the professorship of laryngology at Jefferson Medical School in 1916, a turning point in his life. It was a difficult decision be­cause his mother could not accompany him. Later in life he often quoted her when asked what had motivated him to continue his career.

Well, Chev, it will mean that you and I will not see each other many times before I die, but you must go; it is your duty to go. You will be able to spread much wider the knowledge of your life-saving methods of bronchoscopy. You and I will pass away, but bronchos­copy as you have developed it will go on forever.

Although the move to Phil­adelphia was a professional advancement, Jackson realized that medical faculty status carried no financial compensa­tion; income had to be derived by treating patients. In Phila­delphia, by the 1930s, he held faculty appointments at five medical schools, a unique honor, which allowed him to train a maximum number of medical students and graduate physicians. Virtually personal, one-on-one. instruction was required for the manual tech­niques of peroral surgery. In 1924 he began giving patients’ records, including his own colored drawings, of specific cases – especially the many types of extracted foreign objects – to Philadelphia’s College of Physicians. This made valuable information available to other doctors who might be confronted with similar problems.

Until the 1950s Jackson also taught his methods at medical institutions in other American cities, as well as abroad. He maintained a regular schedule for teaching in Paris, often gave courses in Latin America, and made occasional journeys to Italy and Belgium. A strict instructor, he refused to allow the prestige of an otherwise talented medical student or licensed physician to produce an automatic passing grade in peroral endoscopy. A trainee had to demonstrate his manual dexterity; awkwardness was simply unacceptable. The vibrant Jackson stimulated his students by emphasizing vis­ual aids and utilizing what he called “chalktalks,” which impressed them greatly be­cause he drew sketches accu­rately and swiftly on the blackboard.

Philadelphia had a more sophisticated medical commu­nity than Pittsburgh, but Jack­son surprised his new colleagues by abstaining from any evening social life. Never­theless, strenuous and ex­tended work reactivated his tuberculosis. He first realized it during a medical society banquet when his mouth filled with blood. Alice duplicated their Ohio River sanctuary by locating a dilapidated eight­eenth century gristmill and sawmill on quiet Old Swamp Creek, near Schwenksville, Montgomery County, thirty­-five miles northwest of Phila­delphia. The couple purchased the structure, which they christened the Old Sunrise Mill, and not only renovated the miller’s dwelling space, but also built a modest house on a farmstead nearby. On this property Jackson engaged in his vocation and his avocation. His medical writing was done in a study, as well as in a small boat, powered by a silent elec­tric motor, on the mill pond. In the mill he had a machine shop where prototypes and improvements on the endo­scopic instruments were turned out with his own hands. It was also an ideal setting for more painting.

Although he appeared frail and seemed mild-mannered, Chevalier Jackson was a pug­nacious opponent. Since his early mortifying failure in esophagoscopy, he had set high standards for honesty and professional integrity. And he made enemies.

Not long after he moved to Philadelphia, Jackson – whose teaching position included no salary – set up a private office which he shared with Dr. William H. Spenser in fashion­able Rittenhouse Square. The arrangement called for Jackson to pay Spenser twenty-five percent of cash receipts and fifty dollars for monthly rent; in addition, their names ap­peared jointly on office stationery. After several years Jackson discovered that Spen­ser had been requiring indi­gent ward patients Jackson had been treating to pay fees – ­against Jackson’s express instructions – to the hospital staff, and had himself pock­eted twenty-five percent of those payments. Jackson was further outraged when he learned that Spenser had brought a malpractice suit against a surgeon who had treated his wife. Thoroughly angered, Jackson blocked Spenser’s admission to the American College of Surgeons.

In 1928, with Jackson’s public prestige at its peak, he found himself in disagreement with throat and lung special­ists at the prestigious Mayo Clinic. In an article the Mayo Clinic group recommended that the bronchoscope be em­ployed only as a last resort, and offered a number of alter­native procedures to be used during emergencies. Jackson countered by accusing the Mayo physicians of incompe­tence in handling their bronchoscopes.

He was acutely alert to, and in agreement in principle with, public relations activities. The caustic substances labelling legislation itself largely depended on parents cooperat­ing by keeping the items away from children; a campaign against holding small objects between the teeth was another such matter. In 1924, Jackson made newspaper headlines by advising parents that children not be allowed to eat peanuts because there was a tendency to breathe them in without chewing, and they were difficult to dislodge from the wind­pipe. Two of his efforts to change social habits were totally ineffective, however. Jackson once suggested man­datory placement of gauze covers on telephone mouth pieces to halt the spread of tuberculosis. He also argued that Americans should replace the handshake with the Orien­tal bow as the polite method of greeting, so that germs could not spread from hand to hand.

It was the president of Jefferson Medical College, William Potter, who spurred Jackson to maximize public awareness of his work by seek­ing newspaper coverage. In some respects this resembled the descending path toward low standards which Sinclair Lewis had deplored in Arrow­smith, although the tacts taken by Potter and Jackson never allowed poplar tastes to prosti­tute professional goals. On some occasions Jackson was embarrassed by media cover­age. In the case of the death of an eighteen-month old grand­son of a prominent Chestnut Hill banker, a newspaper ac­count incorrectly reported that Jackson had performed bron­choscopy unsuccessfully, when in fact another physi­cian, on duty at Jackson’s clinic, had attempted the pro­cedure. But Jackson’s appeal against children eating pea­nuts was just the sort of thing that captured public imagina­tion, as did many stories of the rich and famous who chose to be treated by Jackson because he was the world’s best in his field.

Public relations clearly reaped handsome benefits for Jackson in 1927 and again in 1928. Jackson received a Philadelphia man-of-the-year award named for Edward Bok, the successful editor of the Ladies’ Home Journal. The award’s text inaccurately praised Jackson as the inventor of the broncho­scope, an accolade he humbly disclaimed. The following year he received the Dr. Henry Jacob Bigelow Medal, a prize honoring a famous Boston surgeon and medical professor who had been the first to oper­ate with a truly effective anes­thetic. Honors, of course, did not advance bronchoscopy. However, Dr. Bigelow’s de­scendant, Frederick S. Bige­low, who had moved to Philadelphia, where he was an editor of the Saturday Evening Post and trustee of the Univer­sity of Pennsylvania’s Gradu­ate School of Medicine, donated money for a Chevalier Jackson Bronchosopic Clinic at Penn. For a decade the clinic was the center of much of Jackson’s work.

In 1938 Jackson chose to retire from full time medical school teaching. Jefferson Medical College made him an attractive offer as director of a proposed peroral clinic, with the understanding that he could direct from afar and work at his own convenience. Instead, he chose to remain active at the throat and bron­choscopy clinic at Temple University Medical School, in part because his son, Dr. Chevalier Lawrence Jackson, had dedicated his career to the school. He may also have been swayed by Temple’s traditional concern for Philadelphia’s common people. In any case, the old man was not ready to withdraw to a part-time advisory role.

“C. L. ,” as the younger Dr. Jackson was familiarly known (to distinguish him from “C. J.”), had been brought up differently than his father, but inherited or developed a re­markable number of abilities. The fear of poverty and the torment by schoolmates did not dampen C. L.’s spirits nor affect the harmony of the Old Sunrise Mill. The family en­joyed living in the peaceful countryside, as a series of humorous imitation threaten­ing notes, typed deliberately in broken gangster English, re­veal. (The notes, part of the National Library of Medicine’s Jackson Papers, date from about the time of the Lind­bergh baby kidnapping.) There were barn dances at Old Sunrise Mill and leisurely afternoon lawn parties during which guests played croquet.

Young Chevalier Lawrence Jackson was an honors student in languages at the University of Pennsylvania, sharing a love of French with his father. He developed a penchant for opera and later became the president of the Philadelphia Opera Company. An expert bronchoscopist, he took over direction of the overseas in­structional clinics. He was more than competent as a medical illustrator and au­thored several advanced text­books on peroral surgery. After World War II, research in throat and lung illnesses, as in most other fields, was increas­ingly concentrated on cancer, and the younger Jackson con­tributed much in that area. His death in 1961, three years after his father, left a major void in the medical world.

Ironically, fully-flexible fiber optic endoscopes, first suc­cessfully used in 1957, have replaced Jackson endoscopes for most diagnostic missions, the original role of all endo­scopes. The fiber-optic phe­nomenon provides light to the interior problem area and transfers clear images by cable to the surgeon’s eye. The cable can be easily pushed gently into body openings. In addi­tion, heart sustaining devices and powerful antibiotics make cutting surgery more practical in regions deep within the chest, areas formerly ap­proached by peroral instru­ments. However, Jackson-type rigid bronchoscopes and esophagoscopes are still neces­sary for keeping air passages open and for retrieving foreign bodies.

At his death in 1958, it was estimated that Chevalier Jack­son had personally saved five thousand lives, and that those taught by him probably had saved a half million more. The young man from Pittsburgh who had tenaciously overcome bitter humiliations in child­hood, the caring physician who had struggled against all odds and failures, and the exacting artist who had con­tributed greatly to the arts and the sciences, had given gener­ously of himself. How grateful Pennsylvanians – and the entire world – should be for his selfless humanitarian labors.

For Further Reading

Bauer, Edward Louis. Doctors Made in America. Philadelphia: J. B. Lippincott Company, 1963.

Castiglioni, Arturo. A History of Medicine. New York: Alfred A. Knopf, 1941.

Jackson, Chevalier. The Life of Chevalier Jackson: An Autobi­ography. New York: Macmillan Company, 1938.

Katzir, Abraham. “Optical Fibers in Medicine.” Scientific Ameri­can. 260, 5 (May 1989): 120-125.

Mackenzie, Morell. The Fatal Illness of Frederick the Noble. London: Low, Marston, Searle & Rivington, Ltd., 1888.

Munro, Thomas. “Impressionism in Art.” Dictionary of the His­tory of Ideas. 2: 567-583. New York: Charles Scribner’s Sons, 1973.

Stevenson, R. Scott. Morell Mackenzie: The Story of a Victorian Tragedy. London: William Heinemann, 1946.

The author wishes to thank the following for making primary sources available for this article and for explaining aspects of Chevalier Jackson’s life and work: Dr. Bernard R. Marsh, Professor of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical School; Philip Seitz, Curator, American Academy of Otolaryngology-Head and Neck Surgery; Judy M. Chelnick, Division of Medical Sciences, Smithsonian Institution: Mr. and Mrs. Frank Bugbee of Schwenks­ville, descendants of Dr. Jackson; the staff of the College of Physi­cians of Philadelphia; and the staff of the History of Medicine Divi­sion, National Library of Medicine.

Louis M. Waddell is the associate editor of Pennsylvania Heri­tage. He has served as associate historian of the Pennsylvania Historical and Museum Commis­sion’s Division of History since 1973. He received his bachelor of arts degree from Princeton Uni­versity, his master of arts degree from New York University, and his doctorate from the University of North Carolina at Chapel Hill. He is the editor of the multi­volume series, The Papers of Henry Bouquet, published by the Pennsylvania Historical and Museum Commission.