What happened here? Hirschsprung’s disease. As J.W.’s embryonic self was laying down nerves along the length of the colon, the process petered out. The final stretch was left without. As a result, peristalsis—the wave of contraction and dilation that moves things through the gut—stops right there. Digesta pile up until the pressure builds to a point where it shoves things through. The shove might happen every few days, or it might take weeks. Just behind the dead zone, the colon becomes overstretched and damaged—a floppy, passive, swollen thing. The megacolon may eventually take up so much room that it begins to bully other organs. Taking a deep breath is a struggle. J.W.’s heart and lungs were thrust upward and outward to the point where they pushed the ribs aside and began jutting horizontally from the torso.
Without surgery, a megacolon like J.W.’s will prevail. If the specimen is spectacular enough, it finds its way to a museum, earning a toehold in medical history while the man himself fades to obscurity. This was the case, too, with the megacolon of a Mr. K., written up in the Journal of the American Medical Association in 1902. In a photograph that accompanies the article, the organ lies on what appears to be a hospital bed, as though it grew so big that it eventually eclipsed Mr. K. entirely and the doctors and nurses took to caring for it in his place, changing the sheets, bringing meals on trays, putting bendy straws in its ginger ale. All we know about poor Mr. K. is that he lived in Groton, South Dakota. Everything else has been subsumed by the details of the autopsy and a frightful chronology of doctor-assisted evacuations. From a medical aside, we glean that Mr. K. had a family and that they seemed to care about him: “June 22, the report was received that he had passed an ordinary pailful of feces. . . . There was much rejoicing in the family.”
Anna Dhody, the Mütter Museum curator, led me down to the basement* to see what we could learn about J.W. the man. The file holds a reprint of a paper presented at the College of Physicians of Philadelphia on April 6, 1892, by Henry Formad, Demonstrator of Morbid Anatomy. On top of overseeing the “rather voluminous autopsy,” Formad had interviewed J.W.’s mother. The woman recalled that “disturbances in defecation” and abdominal swelling had been evident by age two, suggesting Hirschsprung’s. J.W. began working at sixteen, first in a foundry and later a refinery. All the while, his belly continued to swell. In a photograph taken shortly before he died, he stands in a doctor’s wood-floor examining room, naked except for hospital slippers, baggy white socks, and a few days’ growth of beard. He looks directly at the camera with a demeanor of calm defiance. Imagine the biggest potbelly, the longest overdue triplets, on a meager frame of knobby limbs. The bastard offspring of Humpty Dumpty and Olive Oyl. To better capture the great torso on film, the photographer had instructed J.W. to raise one hand to his head. The cheesecake pose invites you to stare, but everything else says, Look away.
By the age of twenty, J.W.’s physique had grown so peculiar that he was hired by a freak show in Philadelphia’s old Ninth and Arch Museum. The museum’s first floor housed carnival-style tests of strength and fun-house mirrors, and I imagined J.W. hanging around those mirrors on his breaks, positioning his girth just so and taking in the bittersweet sight of himself as a normally proportioned man. J.W. was exhibited under the carnival name Balloon Man, along with the Minnesota Woolly Baby* and an assortment of other human and animal oddities.
Formad made no reference to J.W.’s emotional state other than to note that he was unmarried and, justifiably, given to drink.
YOU DON’T NEED a megacolon to fall victim to “defecation-associated sudden death,” but it helps. At the age of twenty-nine, J.W. was found dead on the floor of the bathroom at the club where he regularly took his dinners. The autopsy report described the death as instantaneous, but there was no evidence of a heart attack or a stroke. Likewise, our Mr. K. died at 2 A.M. while straining, as they say, at stool.
“That’s what killed Elvis,” said Adrianne Noe. Noe is the director of the National Museum of Health and Medicine, which has its own megacolon, from an unknown party. As we were about to get off the phone, Elvis Presley dropped into the conversation. Noe related that she’d been standing by the megacolon exhibit one day and a visitor told her that Elvis had had one too. The man added that Presley had struggled with constipation his whole life and that as a child his mother Gladys had had to “manually disimpact” him. “He said that’s why Elvis was so close to his mother.”
A quiet moment followed. “Really.”
“That’s what he said.”