Polite Dissent

Y: The Last Man #29 “Ring of Truth: Chapter Three”
Brian K. Vaughan, writer
Pia Guerra, artist

Starting with Y: The Last Man #27, Yorrick becomes very sick. His symptoms begin with the sudden onset of vomiting blood followed by unconsciousness (issue #27). He has very vivid dreams, although they don’t appear to be hallucinations (issues #28 and #29). He is placed on oxygen and develops a fever and diarrhea (issues #28 and #29).

After finding an open dented can of tomato soup, Dr. Mann concludes that Yorrick has not contracted the plague, but has instead developed botulism poisoning. However, based on Yorrick’s signs and symptoms, it seems unlikely that he has botulism; I don’t think her diagnosis is too far off though, he most likely has some other form of food poisoning.

Symptoms of botulism start 12 to 36 hours after ingestion of contaminated food. The classic presentation is “bilateral cranial nerve weakness followed by a symmetric descending weakness.” Let’s put that in English. Botulism usually starts with blurry vision, dry mouth and nausea. Vomiting and diarrhea are common. This is followed by difficulty swallowing and speaking. Weakness then spreads to the upper extremities, trunk, and lower extremities. Respiratory weakness may occur as well. Death due to respiratory failure can occur. Fever should not be present.

Food borne botulism is not caused by a bacterial infection, but instead by the ingestion of a toxin in the food. Thus Dr. Mann’s statement that Yorrick’s body “was rejecting the bacillus” is incorrect because the bacteria itself is not directly involved in his condition. Her statement that “it doesn’t look like the toxin bound to any of your nerve endings” is also incorrect because the toxin binding to the nerve endings is what causes the symptoms in the first place. (However, since it isn’t botulism, her last statement is technically correct since there isn’t any toxin present at all).

Botulism is most commonly caused in the United States by improperly preserved home-canned food. It can occur in commercially prepared food, though that’s extremely rare. Even though botulism is rare in acidic foods (like tomatoes), it can pretty much occur in any type of food.

The treatment of botulism is mostly supportive. The symptoms are treated and the body is allowed to (hopefully) recover on its own. While there is a horse-serum anti-toxin available, it has a fairly high risk of an allergic reaction, so it isn’t used much. When it is used, it is first tested on a small patch of skin to test for an allergic reaction. If there is no reaction, the anti-toxin is given both intramuscularly and intravenously. The anti-toxin needs to be given early in the course of the disease to have an effect.

It takes months to completely recover from botulism and some residual weakness may remain.

Dr. Mann did a thorough exam on Yorrick, including a close examination of his eyes. If there were abnormal pupils or eye muscle weakness, she would have seen them. She also would have noticed any muscle weakness. She clearly noticed his fever since she was placing wet cloths on his forehead. The lack of muscle weakness and the presence of a fever make botulism poisoning unlikely. While Yorrick had vomiting and diarrhea, these are common to most types of food poisoning. I agree that he has some sort of food poisoning, but I seriously doubt that it’s botulism.

Notes:
1. For a horse serum anti-toxin, horses are injected with a particular toxin. The horse is allowed to develop antibodies against this toxin. The serum from the blood of this antibody-laden horse is then purified to make the anti-toxin. Because of the other horse proteins in the serum, there is a high risk of allergic reactions.
2. The nasal canula is drawn correctly. Thank you, Pia Guerra!