Polite Dissent

This is the a look at the medicine in the fifth chapter of Naoki Urawawa’s Monster. Annotations for chapter one can be found here and here, chapter two here, chapter three here, and chapter four here.

There are three major plot events in this chapter: the police look into the murders of the three senior physicians at Eisler Memorial Hospital, the twin children escape from the hospital, and Dr. Tenma finds himself promoted to Head of the Surgery Department.

Medically, it was fairly uneventful except for these two (unrelated) items:
1. A patient was noted to have suffered a brain contusion¹.
2. The police revealed that the dead physicians had all been poisoned with nitrate².

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Notes:
¹ A brain contusion is essentially a bruise of the brain. It can be caused by either a direct (coup) or indirect (contrecoup) injury (which I discussed when taking a look at Jack Cross). Brain contusions are associated with swelling of the brain and a subsequent increase in intracranial pressure. If the pressure goes high enough, it can cause coma or death. About one fifth of patients with a brain contusion also suffer a hemorrhage, such as a subdural hemorrhage (this is what killed the Turkish construction worker in chapter one).

2. Dr. Tenma identifies nitrate as a muscle relaxant, but that’s not quite true. There are two types* of muscle in our bodies. First, there is skeletal muscle (also known as striated muscle). This is what most of us think about when we hear the word muscle. These are the muscles that we voluntarily control, and they are the muscles that help us move our arms, legs, mouth, etc.

The second type of muscle is smooth muscle. We have no conscious control over these muscles, and that’s why they’re also known as involuntary muscles. Smooth muscles are important for the inner workings of our body. For instance, they surround blood vessels and the gastrointestinal tract. They are controlled by the autonomic nervous system.

The class of drugs known as nitrates relaxes smooth muscles. By relaxing the smooth muscles surrounding the blood vessels, nitrates cause vasodilatation — the drug relaxes the blood vessels and allows them to open wider and carry more blood. This lowers the blood pressure, and in fact nitrates were some of the first effective medications for high blood pressure. In addition, this relaxation of the blood vessels allows more blood to get to the heart muscle itself, and that’s why nitrates are used to treat heart attacks and angina. However, too high a dose of nitrates can drop the blood pressure too low. This can lead to loss of consciousness and even death if the dose is high enough. Common nitrate medications include nitroglycerin, isosorbide mononitrate, isosorbide dinitrate, and nitroprusside.

*technically cardiac muscle is considered a third type of muscle as it shares characteristics of both the smooth and skeletal muscles.

Tags: comics medicine brain contusion subdrual hemorrhage nitrate naoki urasawa monster