Can Sleep Speed Healing?

A.“There is no evidence, even anecdotal, that more sleep promotes or accelerates bone healing,” said Dr. Melvin Rosenwasser, an orthopedic surgeon at New York-Presbyterian/Columbia University Medical Center.

“Fractures heal with proper alignment and immobilization,” he said, adding that healing is also affected by“the state of general health, nutrition and habits such as smoking.”

As for what might speed healing, Dr. Rosenwasser mentioned a study that indicates a slight acceleration of healing with ultrasonic stimulation in the treatment of wrist fractures. An analysis of several studies ofultrasoundtreatment for fractures,published in The Canadian Medical Association Journal in 2002, concluded that“there is evidence from randomized trials that low-intensity pulsed ultrasound treatment may significantly reduce the time tofracturehealing for fractures treated nonoperatively.”

But could sleep be a factor in healing other kinds of injury?A 2004 studyin the journal Psychoneuroendocrinology concluded that perceived stress and levels of stress hormones predicted the speed of wound healing but that several other factors, including alcohol consumption, exercise and sleep, did not.C. CLAIBORNE RAY

Readers are invited to submit questions by mail to Question, Science Times, The New York Times, 620 8th Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com.

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Cases— When All Isn’t Enough to Foil Alzheimer’s

Alzheimer’s diseasehad been on his radar ever since his own father died of it. Witnessing the catastrophic deterioration of a man who had been sharp enough to work for Gen. Douglas MacArthur, my frightened father was inspired to become a neurologist. Perhaps the pursuit of medicine could stave off what he believed was a genetic inevitability.

As an ever-present reminder of that threat, he kept an atrophied brain in a jar on his desk. That brain, I recently discovered, belonged to his father.

As my father approached middle age he began to experiment on himself, with diet supplements. By age 60 he was taking 78 tablets a day. He tracked down anything that offered the possibility of saving brain cells and killing free radicals: Omega 3s, 6s, 9s;vitaminsE and C; ginkgo biloba, rosemary and sage;folic acid; flaxseed.

After retiring from his neurology practice in Naples, Fla., he spent hours a day doing math. Even when I was visiting, he’d sit silently on his leather recliner with a calculator to verify the accuracy of calculations he did by memory.

“What are you saving your mind for, Dad?” I often wondered to myself.“I’m here now, waiting to talk with you.”

On one of these occasions, he suddenly looked up from his Sudoku game and stared at me.

“Promise me something, gal,” he said.“Anything,” I answered.

“Swear on your grandmother’s Bible that you will put a gun to my head if I wind up like my father.”

He was dead serious.

How do you answer a man who watched his father wipe feces on the walls of their Virginia farmhouse? A man who took out a second mortgage to buy the first CT scanner in Florida?

“Swear to me,” he repeated. He collected guns and kept them under lock and key. He knew I could shoot them, because he’d taught me how.I put my hand on the leather-bound King James Bible that had belonged to my great-grandmother Nannie Dunlap and my grandmother Nancy Scott.

“I swear,” I said.

He nodded in approval.

A few years later, my father arrived at my home in Vermont with a suitcase full of supplements. He parceled out his pills for the week into Dixie cups, ready for swallowing with every meal.

“Gal, you should be taking these, too.”

“Why?”

“Because you are my genetic clone.”

Our physical resemblance and character traits were uncanny: tall, big-lipped, blue-eyed, loose-jointed, freckle-skinned, angst-ridden Bercaws. Except for our male and female chromosomes, nearly everything about us was a perfect match.

My father went on to explain that everyone inherits one copy of the APOE gene from each parent. The gene can indicate a predisposing genetic risk for Alzheimer’s. APOE-2 is relatively rare and may even provide some protection against the disease. APOE-3 is the most common and appears to have a neutral role. APOE-4 indicates the highest risk factor.

“I’m only 34! Can’t I think about this later?”

He shook his head.

Back in Florida, he sent me a genetic test kit via Federal Express, instructing me to have the blood drawn at my physician’s office but to have the results sent to him. It turned out that like my father I carry the APOE-3 gene, which means I may or may not get the disease.

But unlike my father, I will have to wait to find out. In 2009, at age 71, he had anM.R.I.that showed“atrophy consistent” with Alzheimer’s disease. He looked at the film and was confused by the sight of his own brain.

I recently spent time with my father while his wife had surgery. I took him to visit her at the hospital each day, and when we got home I stopped him from calling her every five minutes. I gave him dinner and pills at the appointed hours. I cleaned up his“accidents.”

While he watched a televised baseball game one afternoon, I walked into his den and eyed the wall of supplements he used to take— bookcase after bookcase of pills with names like Memoral and Sharp Mind. Won’t be needing them anymore.

I rested my hand on his gun cabinet.Won’t need you, either.

My father walked to the coffee shop with me every morning. The only thing he’d say on these walks was,“The hibisci are in full bloom.” Every time he said it— which was dozens— I wondered whether the plural of hibiscus is, in fact, hibisci.

On the final morning of my visit, he didn’t mention the blooms. But when we passed a particularly flourishing tree, he stopped to look at me.

“Gal,” he said, then paused to find the words.

His voice quivered.“I sure appreciate you coming down to take care of me.”

I composed myself long enough to say:“It was a pleasure, especially after all you have done for me. Besides, you don’t need so much taking care of.”

As we walked on, my father would repeat this latest sentence every few minutes— the same quiver in his voice at the exact same place.

Each time, my response got shorter and shorter, until I was the one who had nothing left to say.

Nancy Stearns Bercaw is a writer in Vermont.

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Will Johnson&Johnson Recalls Change the Firm’s Reputation?

“Looking for Tylenol pain relief products?” asks one of the signs. The notices at CVS serve as a stark reproof to Johnson&Johnson, whose brands have for more than a century been synonymous with quality. Some of its products are in short supply at drugstores and supermarkets because the McNeil Consumer Healthcare unit of J.&J. last year recalled about 288 million items, including about 136 million bottles of liquid Tylenol, Motrin, Zyrtec and Benadryl for infants and children.

Johnson&Johnson has had to recall such a variety of products because of quality-control problems across product lines, in multiple factories and in several units last year. Some of its consumer products, for instance, may have contained bits of metal. Others came in bottles with a moldy smell. And some products have gone missing from stores with hardly an explanation. All of this has put the company and its manufacturing under the intense scrutiny of lawmakers and officials at theFood and Drug Administration.

“It looks like a plane spinning out of control,” says David Vinjamuri, a former J.&J. marketing employee who now trains brand managers at his company, ThirdWay Brand Trainers.

While the drugstore signs that helpfully suggest“Try CVS/pharmacy brand” are intended to assist frustrated shoppers in identifying alternatives to missing brand-name products, they also serve as constant reminders of another of J.&J.’s continuing problems: It must persuade millions of disappointed customers to once again pay a premium for products that may no longer seem to be of any higher quality than the less expensive store brand.

“I don’t even consider buying them any more,” says Thien-Kim Lam, a mother of two and abloggerin Silver Spring, Md. In a post last spring titled“Makers of Tylenol, I’m Disappointed in You”on the blog DC Metro Moms, Ms. Lam wrote about the huge recall of J.&J. infants’ and children’s medicines.

Now, she says, the frequent recalls have prompted her to switch to generic cold and cough medicines for her children.“It’s like a breakup,” she says.“I’m done. I’ve moved on.”

Bonnie Jacobs, a McNeil spokeswoman, says the company is committed to restoring McNeil’s reputation as a world-class manufacturer of over-the-counter medicines.“We will invest the necessary resources and make whatever changes are needed to do so, and we will take the time to do it right,” she wrote in an e-mail last Thursday.

If Queen Elizabeth II had been the chief executive of Johnson&Johnson, she might have called 2010 an“annus horribilis.”

J.&J.’s troubles with some of its consumer products began in earnestlast January, when McNeil recalled millions of pill bottles after some consumers complained that they smelled like mold. By December, when itrecalled 13 million packages of Rolaids soft chewsthat may have been contaminated with metal or wood particles, the company had closed one plant in Fort Washington, Pa., for an overhaul and had yet to solve the quality problems at another, in Puerto Rico.

The response of J.&J.’s chief executive,William C. Weldon, has been to allocate more than $100 million to upgrade McNeil’s plants and equipment, appoint new manufacturing executives, hire a third-party consulting firm to improve procedures and systems at McNeil and shore up quality control companywide. InCongressional testimonylast fall, he promised that when the Pennsylvania plant reopened, it would“represent the state of the art in medicine production.” And he has repeatedly tried to reassure consumers, ashe didwhen he promised that J.&J. had“no higher concern than providing parents with the highest-quality products for their children.”

Those reassurances, however, have been followed by yet more recalls. What is most perplexing is the seeming inability of executives to solve— and satisfactorily explain— the manufacturing issues that dog the company. Federal regulators have continued to fault the McNeil unit for failing to identify and address systemic problems at its plants, and consumers remain mystified about why simple products like O.B. tampons can disappear from drugstore shelves.

In July, McNeil submitted a plan to the F.D.A. detailing how it intends to overhaul its operations. To comply with regulatory standards, McNeil is undertaking thorough manufacturing and quality-control reviews for all its products, Ms. Jacobs says.

That means the recalls may continue. Last Thursday, Ms. Jacobs said the company would“take whatever steps are needed to ensure our products meet quality standards, including further recalls if warranted.”

Only a day later, McNeil recalled 47 million units of Sudafed, Sinutab, Benadryl and other drugs from wholesalers because of issues like inadequate equipment cleaning practices. The company said that the recalls were not a result of health problems and that consumers could continue to use the products.

JOHNSON&JOHNSON, with about $62 billion in sales in 2009, makesthousands of different kinds of products, including Band-Aids, baby shampoo, cardiacstentsand advanced drug treatments forrheumatoid arthritis. It solidified a reputation for product quality witha company credo, dating from 1943, saying that the company owed its first responsibility to the mothers and fathers, doctors, nurses and patients who use its products.

With such a diversity of products and operating companies, Johnson&Johnson’s overall business has not suffered significantly. But the string of recent recalls at McNeil threatens to weaken the kind of trust that made many people willing to pay more for J.&J. brands.

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Justices Hear Arguments on Disclosure in Zicam Case

“What do you think about Satan?” Justice Scalia asked a lawyer for the government, who was just starting his argument.

The case,Matrixx Initiativesv. Siracusano, No. 09-1156, was a class action against Matrixx Initiatives, an Arizona company accused of committing securities fraud by failing to tell investors of reports that its main product, a nasal spray and gel called Zicam, might have caused some users to lose their sense of smell. The condition is known asanosmia.

After a link between Zicam and anosmia was reported on“Good Morning America” in 2004, the company’s stock dropped 24 percent. In 2009, theFood and Drug Administrationwarnedconsumers not to use the products, which had been sold as over-the-counter homeopathic medicines, and Matrixx recalled them.

Satan came into the case by way of analogy. Matrixx contended that it should not have been required to disclose small numbers of unreliable reports of adverse effects, which were all it said were available in 2004.

“For years many consumers would not purchase products fromProcter&Gamblebecause of a ridiculous rumor that the company was Satanic,” Matrixx said in a recentbrief.“But no decision of this court bases securities-law disclosure obligations on how ignorant or paranoid people might react to unreliable or even false information.”

The Supreme Court has said that companies may be sued under the securities law for making statements that omit material information, and it has defined material information as the sort of thing that reasonable investors would believe significantly alters the“total mix” of available information.

Much of the argument revolved around whether reasonable investors would want to know about false and outlandish assertions like the one about Satanism so long as the assertions might affect the price of securities.

“A reasonable investor is going to worry about the fact that thousands of unreasonable investors are going to dump their Matrixx stock,” Chief JusticeJohn G. Robertssaid.

Justice Scalia disagreed.“It seems to me ridiculous to hold companies to irrational standards,” he said.

Though the justices were divided about how to handle reports of Satanism and the like, Matrixx did not appear to get much traction for its main argument— that a failure to disclose reports of adverse effects should give rise to securities fraud liability only if the reports were collectively statistically significant.

It said the plaintiffs had found at most 23 reports of anosmia before the“Good Morning America” report, and it added that anosmia can have many causes.

“All drug companies receive on an almost daily basis anecdotal hearsay reports about alleged adverse health events following the use of their products,” Jonathan Hacker, a lawyer for Matrixx, told the justices.

But the justices appeared almost uniformly skeptical of imposing a requirement of statistical significance, particularly at the very outset of a case.

JusticeElena Kagansaid that the F.D.A. itself did not use that standard, and she added that she could imagine situations in which small numbers of reports of serious harm would meet the securities laws’ requirement of materiality.

Imagine, she said, that a drug company sold a single product, a new contact lens solution that hundreds of thousands of people had used without incident. But 10 went blind, and three who used it in only one eye went blind in that eye.

“There is no way that anybody would tell that you these 10 cases are statistically significant,” Justice Kagan said.

Nonetheless, she asked Mr. Hacker,“would you stop using that product and would a reasonable investor want to know about those 10 cases?” He said no.

Justice Kagan responded that“there are a lot of contact lens solutions in the world.”

“I’d stop using the product,” she said,“and if I were holding stock in that company, I would sell the stock.”

Pratik A. Shah, the government lawyer asked about rumors of Satanism by Justice Scalia, said there were circumstances in which a company should have to disclose such rumors.

Investors would almost certainly think it material to know, he said, for instance,“however ridiculous it is and untrue it is, that 10 percent of our consumer base has decided to boycott our products.”

Justice Scalia pressed the point.

“So the government’s position is that reports of adverse effects that have no scientific basis, so long as they would affect, irrationally, consumers, have to be disclosed?” he asked. Mr. Shah said yes, if the company had made affirmative statements about the subjects at issue. Matrixx had called attributing anosmia to Zicam“completely unfounded and misleading.”

Justice Scalia summarized the discussion near the end of the argument in the case.

“If Satan comes in,” he said,“surely lousy science comes in as well.”

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Buying Sunglasses, UV Rays in Mind

Skiing on fresh snow, skating on reflective ice or hiking at high altitudes can be harder on your eyes than a day at the beach. Snow, as many East Coast readers may have noticed this week, reflects nearly 80 percent of the sun’s rays. Dry beach sand? Just 15 percent.

Most of us already know that ultraviolet (UV) rays can causeskin cancerand other problems. But that’s not all there is to worry about.“Most people don’t appreciate the damage that UV rays can do to their eyes,” said Dr. Rachel J. Bishop, a clinical ophthalmologist at the National Eye Institute in Bethesda, Md.

Winter or summer, hours of bright sunlight can burn the surface of the eye, causing a temporary and painful condition known as photokeratitis. Over time, unprotected exposure can contribute tocataracts, as well ascancerof the eyelids and the skin around the eyes.

UV exposure also may increase the risk ofmacular degeneration, the leading cause ofblindnessin people over age 65. While cataracts can be removed surgically, there is no way to reverse damage to the macula, the area in the center of the retina.

Worried? Consider this article license to buy yourself a new pair of UV-protective shades. But don’t let price and style be your only guides.

“Some cheap sunglasses are great, some expensive ones are not,” said Dr. Lee R. Duffner, an ophthalmologist in Hollywood, Fla., and a clinical correspondent for the American Academy of Ophthalmology. In fact, some knockoff designer frames may do your eyes more harm than if you’d worn no glasses at all.

Below, some advice on how to find sunglasses that will protect your eyes without plundering your wallet.

READ THE FINE PRINTProlonged exposure to UV radiation damages the surface tissues of the eye as well as the retina and the lens. Yet while theFood and Drug Administrationregulates sunglasses as medical devices, the agency does not stipulate that they must provide any particular level of UV protection. The wares at the average sunglasses store therefore can range from protective to wholly ineffective.

Look for labels and tags indicating that a pair of sunglasses provides at least“98 percent UV protection” or that it“blocks 98 percent of UVA and UVB rays.” If you find sunglasses without labels, or they say something vague like“UV absorbing” or“blocks most UV light,” don’t buy them— the sunglasses may not offer much protection.

For the best defense, look for sunglasses that“block all UV radiation up to 400 nanometers,” which is equivalent to blocking 100 percent of UV rays, advised Dr. Duffner.

CHOOSE THE RIGHT STYLEIdeally, your sunglasses should cover the sides of your eyes to prevent stray light from entering. Wraparound lenses are best, but if that’s not an appealing style, look for close-fitting glasses with wide lenses. Avoid models with small lenses, such asJohn Lennon-style sunglasses.

Don’t be seduced by dark tints. UV protection is not related to how dark the lens is. Sunglasses tinted green, amber, red and gray may offer the same protection as dark lenses. For the least color distortion, pick gray lenses, said Dr. Duffner.

If you are frequently distracted by glare while driving, boating or skiing, look for polarized lenses, which block the horizontal light waves that create glare. But remember, polarization in itself will not block UV light. Make sure the lenses also offer 98 percent or 100 percent UV protection.

Though the F.D.A. does not require that sunglasses have UV protection, the agency does insist that they meet impact-resistance standards— which basically means they won’t shatter when struck. Even so, if you wear sunglasses while cycling, sailing or gardening, for instance, consider purchasing a pair with polycarbonate lenses, which are 10 times more durable than regular plastic or glass lenses.

AVOID SIDEWALK VENDORSBuy a pair of chic Chanel knockoffs that offer no UV protection, and you might look swell— but your eyes will suffer. The tinted lenses will relax your pupils, letting more damaging radiation hit your retina than if you were wearing no glasses at all.

To play it safe, buy glasses from well-established drug, chain or department stores, rather than from vendors on the street. Shop around: you should be able to find a pair of drugstore sunglasses for $10 to $20 that provide all the protection you need.

Among the recent offerings atSunglasswarehouse.com, for instance, were wraparound and aviator-style sunglasses that came with full UV protection for just $13.

DON’T FORGET THE CHILDRENUpgrade your children from their Dora and Spider-man toy sunglasses to legitimate shades that offer 98 percent to 100 percent UV protection. Children with light-colored eyes are especially vulnerable to sun damage, said Dr. Duffner. The injury is cumulative, so the earlier children get in the habit of wearing shades, the better off their eyes will be.

If your child plays sports regularly, consider also purchasing sport-specific goggles. Eye injuries are the leading cause of blindness in children, and most of those injuries occur when they are playing basketball, baseball, ice hockey or racket sports.

The National Eye Institute says it believes that protective eyewear could prevent 90 percent of sports-related eye injuries in children.

TEST THOSE OLD GLASSESReluctant to pop for a new pair of sunglasses? If you already have a favorite pair but don’t know what kind of protection they offer, ask your local eyewear store if they have a UV meter. This device can measure the UV protection of your glasses and help you determine whether you should buy a new pair.“Most opticians have such a meter and can do this very easily,” said Dr. Duffner.

Even if you wearcontact lensesthat offer UV protection, you’re not in the clear. Contact lenses sit on the cornea in the center of your eyes and so can’t protect the surrounding white area (the conjunctiva) and skin.

“I see many older patients who have growths on the whites of their eyes that were caused by sun damage,” Dr. Bishop said. These yellow bumps, calledpinguecula, often lead to eye irritation and dryness and may eventually disrupt vision. To prevent them, adults with contact lenses still must wear sunglasses outdoors.

Lastly, if you wear prescription glasses, you can avoid buying sunglasses by either purchasing clip-ons that attach to your frames or having a UV coating applied to your lenses. Presto, you’ll have two pairs in one.

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In Tucson Shootings, Legal Strategy May Hinge on Mental Assessment

Even if that is found to be true, the lawyers for Mr. Loughner, the 22-year-old college dropout who has been charged in theTucson shootings, may find it difficult to mount a successful insanity defense.

The rules regarding such a legal strategy were tightened over the years in the wake of the verdict forJohn W. Hinckley Jr., who was found not guilty by reason of insanity in the 1981 assassination attempt on PresidentRonald Reagan. The insanity argument is now seldom successful, legal experts said.

What is more likely, they say, is that Mr. Loughner’s lawyers will use anymental healthproblems they find to stave off the death penalty, if he should go to trial and be convicted.

His lawyer,Judy Clarke, is likely to begin a far-ranging investigation of his life and family history, going back several generations to learn as much as possible about his origins, the environment in which he grew up and how he has functioned in society, said David I. Bruck, who worked with Ms. Clarke in the defense of Susan Smith, the South Carolina woman who drowned her two young sons in 1994 and who received a life sentence.

Ms. Clarke“will present a case which is focused, grounded in the facts, thorough and heartfelt,” said Mr. Bruck, a veteran death-penalty lawyer and a professor at Washington and Lee University in Lexington, Va.“She won’t try to sell what she wouldn’t buy. She’s going to find this man’s story, and once she’s found it, she’s going to be confident about telling it to a jury.”

But just where Ms. Clarke will tell that story— and before how many juries— is unclear.

The defense could ask that Mr. Loughner’s case be moved from Arizona out of concern that potential jurors might be influenced by news accounts.

Mr. Loughner (pronounced LOF-ner) may also have to be defended in separate trials brought by federal and state prosecutors, who are both likely to seek the death penalty.

The federal government has charged Mr. Loughner in the killings of two federal employees— JudgeJohn M. Roll, the chief federal judge for Arizona, andGabriel Zimmerman, an aide to RepresentativeGabrielle Giffords— and the Pima County attorney, Barbara LaWall, has said she will“pursue charges on behalf of the nonfederal victims.”

Her office has been researching the issue of whether it can proceed at the same time as the federal prosecutors, or whether the state’s case will have to wait until the United States attorney’s office has finished its work.

“I think initially there’ll be some confusion as to who’s going to go first, and how fast they are going to go,” said Rory Little, a former Justice Department official in the Clinton administration who teaches at the Hastings College of the Law in San Francisco.

“I would guess that you’re having some pretty intense discussions now between the federal government and the state side, and it wouldn’t surprise me to see the case divided up,” he said.

Either way, federal and state prosecutors would have two opportunities to seek the death penalty against Mr. Loughner if they chose to do so. That occurred in the case stemming from the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, which killed 168 people, including infants and children in a day care center. One defendant,Timothy J. McVeigh, received the death penalty at his federal trial, but a second,Terry L. Nichols, did not.

Mr. Nichols was tried again, on state charges, in McAlester, Okla. He was again spared execution.

Beth A. Wilkinson, a member of the federal prosecution team in the Oklahoma City case, said of the Tucson shootings:“In a crime like this, it’s also very important to recognize the state’s interest in prosecuting murder and attempted murder of their citizens. The vast majority of murder cases are prosecuted by state authorities.”

Neither the Justice Department nor the Pima County attorney’s office have said if it would pursue the death penalty against Mr. Loughner.

One of Ms. Clarke’s critical early steps will be to argue against any federal death-penalty case through a written submission and in meetings with federal prosecutors in Arizona and with the Justice Department’s Capital Case Committee in Washington. Attorney GeneralEric H. Holder Jr.will have the final say.

Aitan D. Goelman, who also was involved in the federal prosecution of the Oklahoma City case, said he doubted that an effort to block a death-penalty prosecution would prevail.“These kinds of cases are essentially the reason we have the federal death penalty,” he said.

The federal complaint against Mr. Loughner charges him with the murders of Judge Roll and Mr. Zimmerman, along with the attempted murders of Ms. Giffords, who was struck in the head but survived, and of two of her staff members, Pamela Simon and Ronald Barber, who were both wounded and were expected to recover.

One complication is that Mr. Loughner’s lawyers can only pursue the insanity defense if the defendant approves, said Stephen J. Morse, a professor of law and psychiatry at the University of Pennsylvania.

“It cannot be imposed on a defendant over his objection,” Professor Morse said.

He said that lawyers in federal court tend to regard the insanity plea as“a defense of last resort, because juries are skeptical of claims that a defendant was not responsible for his actions.”

Still, he said, given early accounts of the evidence that has surfaced in the Tucson case— that Mr. Loughner appears to have carefully planned his attack on Ms. Giffords— his only chance might be to invoke such a defense.

“Based on the early information,” Professor Morse said,“I would be surprised if he didn’t, because he seems to have no other defense as far as I can tell.”

Marc Lacey contributed reporting from Tucson.

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Swallowed Objects That Went Straight Into History

A laryngologist who worked in the late 19th and early 20th centuries, he preserved more than 2,000 objects that people had swallowed or inhaled: nails and bolts, miniature binoculars, a radiator key, a child’s perfect-attendance pin, a medallion that says“Carry me for good luck.”

Jackson retrieved these objects from people’s upper torsos, generally with little or noanesthesia. He was so intent on assembling his collection that he once refused to return a swallowed quarter, even when its owner threatened his life.

“He was a fetishist, no question,” said Mary Cappello, the author of“Swallow” (New Press), a new book about Jackson and his bizarre collection.“But his obsession had the effect of saving lives. That’s kind of amazing, and lucky for us that his madness made possible forms of rescue.”

Jackson was an artisan and a mechanical prodigy, a humanist and an ascetic whom colleagues sometimes described as aloof or cold. He spent hundreds of hours crushing peanuts with forceps to learn exactly how much pressure to exert. He experimented extensively on mannequins and dogs.

In those days surgery was associated with high mortality, and few physicians were willing or able to peer into the air and food passages, let alone remove objects like open safety pins. Yet Ms. Cappello writes that the survival rate among patients from whom he removed objects was better than 95 percent.

“If Jackson could tell us how he wished to be remembered, I’m certain he would do so by assemblage, or meaningful collage,” said Ms. Cappello, an English professor at theUniversity of Rhode Island. For him, collecting was a form of self-portraiture as well as a clinical and scientific pursuit.

Jackson viewed the world as a precarious place. Small and bookish as a child, he endured intense torment and bullying; at one point other children blindfolded him and threw him into a coal pit, and he was rescued only after a dog happened to find him unconscious.

So in a sense, Ms. Cappello said, when Jackson became a physician— first in Pittsburgh, then Philadelphia— he“was saving lives, yes, but he was also saving himself.” He grew to be a pioneer of the upper body, developing new endoscopic techniques for peering into dark recesses.

He attached a tiny light called a mignon lamp to the end of a rod that he inserted into his scopes. (Previously, physicians who used endoscopes had worked mainly with light held outside the body.)

And he was an early and outspoken safety advocate, particularly when it came to children. As one of his assistants put it, his quest was to make the public and the medical profession“foreign-body-conscious” about swallowing.

If it had been up to him, Ms. Cappello said,“parents who fed peanuts to children without molars would be drawn and quartered.” Chew everything thoroughly, he exhorted the public:“Chew your milk!”

And he lobbied for passage of the Federal Caustic Poison Act of 1927, which required manufacturers to place warning labels on poisonous substances like lye, which burns the esophagus and causes severe scarring that can make it impossible to swallow.

Children often ingested lye because it was present in many households (where it was used to make soap) and because it looked like sugar. A 7-year-old girl who could not swallow even a drop of water was taken to Dr. Jackson, who fed an endoscope into her esophagus and removed a grayish mass— perhaps food, perhaps dead tissue— with a forceps. Afterward, one of his assistants gave the child a glass of water.

“She took a small sip expecting it to choke her and come back up,” Jackson recalled in his 1938 autobiography.“It went slowly down; she took another sip, and it went down. Then she gently moved aside the glass of water in the nurse’s hand, took hold of my hand and kissed it.”

Jackson also developed a technique for dilating the esophagus in children with scarring. He taught them to swallow a long tube and to do so regularly for an extended period. He suggested they might think of themselves as sword swallowers and imagine that the feat“inspires awe in other children.” This eventually helped many of them to eat and drink again normally.

To remove objects like keys and coins and pins, Jackson would insert a long, rigid tube into his patients— usually children, and usually awake, though his assistants did help to hold them still.“He must have had an exquisite gentleness and ability to calm people,” Ms. Cappello said. He also treated many poor children without pay.

Still, his eccentricities marked him.“Some people might have painted him as a socially phobic, friendless loner,” she added.“He was not a warm and fuzzy doctor.”

Nor would he compromise when it came to his collection. In the case of that swallowed quarter, he told the patient’s infuriated father that“all foreign bodies removed from the air and food passages were put into a scientific collection where they would be available to physicians working on the problems of relieving little children.”

The father had beaten the boy as punishment, and when he didn’t get the coin back he apparently beat him again, so viciously he broke his son’s arm.

At that point Jackson gave the family a half dollar. But he did not return the swallowed coin.

The Jackson collection is now owned by theMütter Museum of the College of Physicians of Philadelphia, which is refurbishing it for an exhibition that is to open Feb. 18. Ms. Cappello will help curate the exhibition; Anna Dhody, the museum’s curator, called her work a substantial contribution that“we’re very lucky to have.”

Dr. V. Alin Botoman, a gastroenterologist at theUniversity of Miamiwho has also done scholarly work on Jackson, called him“truly a renaissance man who made so many contributions to medicine and has been all but forgotten.” Until now. In October, Ms. Cappello gave a lecture on Jackson atthe Observatory, an art and events space in Brooklyn. She also presented black-and-white films from Jackson’s family that had never been seen in public.

In a series of clips, Jackson is shown on a small boat, looking out at the sky. He is riding in the back of a pickup truck, writing intently.

His granddaughter, then a toddler, wobbles across a lawn holding a stuffed animal and a flower. She looks at the camera, shakes the flower and puts it in her mouth.

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