Polite Dissent

Continuing my medical annotations of Volume 1 of Black Jack, by Osamu Tezuka, and published by Vertical. This post looks at the six stories that make up the second half of the volume, plus the story “The Two Jans” which is found in the hardcover edition only.

Several of my favorite stories in this volume will be covered in this post. I was particularly fond of “Star, Magnitude Six,” “The Legs Of An Ant,” and “Two Loves.”

There are mild spoiler warnings for this post, but not as significant as part one of the annotations. Click on “Read More” to view the rest of the post.

7. The Painting Is Dead (1976)
A famous artist is painting on a remote tropical island when he is caught in the blast of an atomic bomb. He knows that he is dying, but asks Black Jack to keep him alive long enough so that he can finish a painting warning the world of the dangers of atomic weapons.

The artist suffers what appears to be Acute Radiation Sickness. His symptoms seem to be consistent with an exposure to 600-1000 REM or greater. This amount of exposure is nearly 100% fatal within 2 weeks, which is the time course mentioned by Black Jack. Death is usually due to infection, internal bleeding, or severe gastrointestinal bleeding. He has also suffered Cutaneous Radiation Syndrome, causing the burns and ulcerations of his skin. For any survivors, the risk of cancer later on in life is dramatically increased (and sterility is common).

I assume this goes without saying, but just in case: a brain transplant is total fiction.

Keloid — a thickened overgrown scar.

8. Star, Magnitude Six (1977)
The chief of surgery at a prestigious hospital has died, and now its two most famous surgeons are competing for the job. But are they really the most qualified in the hospital?

When Dr. Shiitake comes upon the wounded man with the crushed arm, he realizes that the pain from the arm is causing the victim to succumb to shock. Thus Dr. Shiitake performs a brachial plexus block (the brachial plexus is a collection of nerves in the shoulder that contains all the nerves of the arm). This nerve block deadens the pain in the entire arm. Shiitake is using the classic above-the-collarbone supraclavicular approach
(If you’ve ever had an ingrown toenail removed, the doctor numbs up the entire toe with just a two injections of anesthetics at the base of the toe. This is the same idea, only larger.)

Tetanus is common in burn victims so that’s why he is using “anti-tetanic serum.” When this story was published, this would have been made from horse serum, but now human Tetanus Immune Globulin is used instead.

Xylocaine = lidocaine = a local anesthetic.
Cardiotonic = a drug which strengthens the heart beat
Digitalis = a classic cardiotonic drug. It’s not used much any more as 1) more potent drugs have been discovered, and 2) it has a very small therapeutic index (the difference between the perfect dose and a toxic dose is tiny). Also known as digoxin or lanoxin. It slows the heart rate and increases heart contraction.
ACH = acetylcholine. Primarily a neurotransmitter. It slows the heart rate and reduces heart contraction.
Vitamin K = a vitamin that plays an important role in the blood clotting system. Classically given during surgery to prevent excess bleeding.

9. Black Queen (1975)
That’s a rather brutal approach to amputation the Black Queen is taking, but it’s an appropriate way of going about it, particularly when an amputation required because of trauma.
The surgical images on page 196 are quite good and show the anatomy of the lower extremity, mostly the upper leg.

10. U-18 (1976)
Black Jack meets HAL, Computo, and the Ultimate Computer all rolled into one.
No real medicine in this story, per se.

11. The Legs of an Ant (1974)
This is a good story for several reasons, but mostly because it succinctly demonstrates how devastating polio was. Thanks to vaccination, polio has been wiped out from the United States (and Japan), so we no longer have to deal with crippled children like jo jo, or with those doomed to remain in an iron lung for the rest of their life.

Unfortunately, we’re victims of our own success with vaccination, and since few people remember polio, it’s easy for the public to lose sight of how nasty a disease it was and how important polio vaccination is. Thanks to the misguided anti-vaccination movement, I fear it is only a matter of time before polio makes a resurgence — we’ve already seen a dramatic increase in measles cases in the past few years.

Stories like this should be required reading for all parents who make the unfortunate decision not to vaccinate their children.

12. Two Loves (1974)
Until recently I would have said that the idea of an arm transplant is pure fiction, but then the news broke of German farmer who received a double arm transplant just a few weeks ago. From the sound of things, I doubt he’ll ever regain enough fine motor control to make sushi, let alone the best sushi in all of Japan, but it’s a step in the right direction.

13. The Two Jans (1974)
Black Jack is called on to separate conjoined twins who share a brain and take turns using it. Only one of the twins will be able to survive, and that is only if Black Jack can succeed with the difficult surgery.

Good anatomical art (pages 303-305). I particularly liked the panel with the facial muscles on page 305.

Hudson Drill = a special drill used for brain surgery
Oscillograph = an older method used to determine blood flow during vascular surgery.
Cheyne-Stokes Respirations = an abnormal breathing pattern that can be seen in patients nearing death.
Cardiotonic = a drug which strengthens the heart beat.